WhiteCoat

Medical Misdiagnosis

I shook my head as I read the article “Medial misdiagnosis: The right to treat patients unfairly” by Nikki Weingartner.

I agree with the author. Medical misdiagnosis undoubtedly exists. The problem with her article is that it raises an issue, creates critiques that are unwarranted, and then proposes no solution.

She briefly mentions the training that physicians must go through in order to get their MD degree so that they can “brandish their pride and prejudice,” and, in some cases “boast[] an undertone of arrogance.” Then she states that professionals who are paid, on average, $150,000 per year are paid not to find a correct diagnosis, but rather to “perform exams, assess symptoms, write prescriptions, … and, if necessary, perform surgery.”

If you want to criticize physician salaries, read this article by Mike Royko first.
And there is a saying in medicine that “surgeons heal by cutting.” You just take your tirade a little too far.

Ms. Weingartner criticizes physicians for missing a case of lymphoma when a woman complained of night sweats, then in the same paragraph, she states that lab errors “give physicians a tool to proceed with sometimes deadly consequences.” Lymphoma can’t be diagnosed without lab tests, ma’am. Which should we choose?

Then she discusses how the symptoms of TIA, panic attacks, heart attacks, cerebral aneurysms, and status migrainosis can apparently all be similar, warning that “to mistake one for another could prove fatal.”

Obviously Ms. Weingartner must have the inside track on how to be 100% accurate in diagnosing vague symptoms. You’ve blown our cover. Now everyone knows that I and most other doctors are just overpaid dimwits. So give it up. Tell me how to diagnose TIAs, panic attacks, heart attacks, cerebral aneurysms, and “status migrainosis” with 100% accuracy in each and every case. Save us from ourselves.

I agree with you on one point: Doctors can do better. But we can’t do better by being forced to see more patients in a shorter amount of time with less reimbursements.

The New York Times article you quoted has a quote from Mark McClellan: “You get what you pay for … and we ought to be paying for better quality.”

Your article makes it appear that you are one of the many people in this country who demand perfection from an inexact science.

How much are you willing to pay for it?

9 Responses to “Medical Misdiagnosis”

  1. Marilyn says:

    Interesting article with much personal application, though I don’t agree with the underlying suggestion that medicine could be a perfect science and misdiagnosis should happen to no one.

    My dad (may he be remembered for a blessing) always said “hindsight is 20-20″. It’s like doing a post-mortem on a football game, you can always see what you should have done after the event is over.

    I should have much empathy for the ideas expressed in Ms. Weingartner’s article. My family has suffered mis-diagnosis a number of times.

    My dad was having vague pains along his jawline and thought it was a bad tooth. Nope. Arteries were clean. He also had a mild sore throat and a little cough. He was diagnosed with “GERD” and sent home with instructions to raise the head of his bed 6 inches, not eat late at night. Several months later, no relief, he was then diagnosed with “allergies” and given nasal steroids and antihistamines.

    Hmmm. The allergies didn’t get better. Several months later (I think about 9 months from when he first sought care) “…oops…you have Stage 3 adenocarcinoma on your lung…”

    It didn’t show up on xrays. My dad was low-risk for lung cancer, he never smoked, never worked where his lungs would have been compromised. It could most likely have been cured (5-year death rate is under 2% in cases with early intervention) had they found it at onset of symptoms but as you all know, it is aggressive and got away from everyone. He was dead 4 months later.

    I have suffered, my grandmother suffered. I’ll spare you any more personal stories.

    It did not drive us into the courtroom. We simply did not have “classical” presentations of our problems. It DID drive me to the Internet to become well-informed so that I could ask my doctor pointed, detailed questions about obscure medical things. Thankfully my doc doesn’t mind me working in partnership with her as much as I possibly can. Knowledge has been a healthsaver, kept me out of an ever increasing spiral of drug-dependence and nasty side-effects. Who would have guessed that panic attacks were caused by a LOW thyroid?

    I have extreme appreciation for what a doctor goes through in training and the expertise he/she has. But I don’t believe anyone can be expected to be expert on every single medical issue that is out there and all the possible presentations of said issues. You would have to have your head into the medical journals 24/7. You would have to run every conceivable test and every available type of imaging on every patient to catch the weird stuff. Even with our experience, I think that is an unreasonable expectation.

    I hate to say it but even with our best efforts sometimes people just die. Sad, but a hazard of living.

    All this to say, most of you guys are doing a good job. I am grateful you are doing it, and most of you more than earn whatever it is you are getting paid for it.

  2. Marilyn says:

    Oops…humble apologies for all the italics. Wish we could edit our comments…

  3. Rogue Medic says:

    She briefly mentions the training that physicians must go through in order to get their MD degree so that they can “brandish their pride and prejudice,” and, in some cases “boast[] an undertone of arrogance.”

    I just go to the literature section, under A, to brandish Pride and Prejudice. Think of the savings.

    Undertone of arrogance? I am no slouch in the arrogance department. If it is just an undertone, you aren’t doing it right. ;-)

    She did not miss too many cliches in this. not cliches that enlighten or entertain, but cliches that distract from the subject.

    Another story shows how one of the elite United States Army Special Forces soldiers was kicked out of the group and court martialed because of his forgetful behaviour. That behaviour was due to symptoms of a rare brain eating disease called Creutzfeldt-Jakob disease.

    CJD is rare. A zebra. It would be wrong to start an evaluation looking for this. The benefit from a correct initial diagnosis would have been what? Should CJD patients be in the special forces?

    Pay no attention to the guy with the unsteady gait, trying to sneak up on you. Or. He was a sniper before the CJD. Now he just nukes everything. It is a horrible disease. It is a rare disease. It should not be suspected early, especially if its presentation is atypical, as this patient’s presentation was.

    In the comments, Nikki Weingartner writes, I watched a story last night about a teen who died from meningitis and the doc, who talked about how the cases of the disease were much greater just a few year ago are now rare.

    Almost as if vaccines, a form of medicine, are effective at preventing diseases.

    One commenter mentions the problem with alternative medicine. Misdiagnosis and spontaneous resolution (which is common and real, but may be difficult to distinguish from misdiagnosis) are the two things that provide the most evidence supporting alternative medicine. This is not evidence.

    In spite of all of this misdiagnosis, 20% in one quote 40% in another, the life expectancy of people continually increases. Maybe doctors are not as dangerous, after all.

  4. k says:

    Sounds like Ms Weingarten is suffering from the God complex with a concomitant chronic case of rectocranial impaction. Maybe she ought to go for that coffee enema…

  5. ladyk73 says:

    Yep…you should go to school for eight years, work in resident slavery for 2-5 years, have student loans in the 100,000, get sued because 110 year old grandma died, and sorry…
    You max salary will be $80,000!

    Isn’t primary care docs only getting ~$115,000?

    If I see one more ad for homeopathy
    crap like Sinupret and Zicam, I am going to scream. I cannot believe that they sell this crap right next to the “real” drugs.

    Okay…at least Zicam has studies….

  6. I’d just like to point out that the ‘Digital Journalist’ Ms. Weingartner’s other influential and intelligently written articles include:

    -“Polygamy may be good for career people: The Work Spouse”
    -“Gruesome mauling of TV Chimpanzee caught on 911 tape”
    and
    -“‘Skinny’ Wine will be among the Oscar freebies”

    She seems like she’s ready to offer some original solutions to the plight of incorrect diagnoses…like “never events”.

  7. I think i would need more information on the actual diagnoses of those 20%….there’s a lot of weird stuff out there with vague presentations.

  8. Kim says:

    I’ve been at the receiving end of more than one misdiagnosis in my relatively healthy life, one of which cost me dozens of missed school and work days (not to mention ruined vacations) through my late teens and twenties before finally getting down to the business of being life threatening. So I’m somewhat sympathetic to her point. I don’t think anyone expects doctors to be perfect or the science to be exact, but I do think there are plenty of doctors kind of sleep-walking along, not necessarily even keeping their eyes open for the pinto horses (nevermind the zebras). Working in a field where troubleshooting skills are required but a degree of monotony exists, I can understand how it happens, and I understand good doctors no doubt work to avoid it (just as I do). Still, it’s hard to be too too sympathetic when it’s your own quality of life being impacted.

  9. Donna says:

    I came across this article as I was reading for signs and symptoms of missed diagnosis for TIA’s. This doctor (does not give his name) sounds like all he is worried about is getting the right amount of compensation for his wonderful work. Hmmm…I wonder whether or not he has ever been sued for malpractice. I am a decent attorney, who does NOT practice any type of personal injury law, and most of the time, I work “pro bono” (giving my legal services for free). I was always under the impression we choose a career that we are passionate about. I make up my charges and costs/expenses but I am no Perry Mason.

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