Regarding the SEP question about what a doctor said about your symptoms that may have been disheartening, this article today in the Washington Post says that it common, unfortunately.
A cancer surgeon wanted to open my neck when he saw a tiny pimple on it. I insisted on a culture being taken first. He kept refusing but finally had the culture taken and it turned out that it was just an innocent water blister that went away by itself.
Here is the article:
Most Americans will get a wrong or late diagnosis at least once in their lives
Washington Post September 22, 2015
By Lena H. Sun
Most Americans who go to the doctor will get a diagnosis that is wrong or late at least once in their lives, sometimes with terrible consequences, according to report released Tuesday by an independent panel of medical experts.
This critical type of health-care error is far more common than medication mistakes or surgery on the wrong patient or body part. But until now, diagnostic errors have been a relatively understudied and unmeasured area of patient safety. Much of patient safety is focused on errors in hospitals, not mistakes in diagnoses that take place in doctors’ offices, surgical centers and other outpatient facilities.
The
new reportby the Institute of Medicine, the health arm of the National Academy of Sciences, outlines a system-wide problem that experts say affects an estimated 12 million adults each year.
"Diagnostic errors are a significant contributor to patient harm that has received far too little attention until now," said Victor Dzau, institute president, in a statement.
What’s more, errors will likely worsen because of the growing complexity of the diagnostic process and the delivery of health care, according to the committee that conducted the study. The study is the institute's third in a series on patient safety. Its landmark 1999 report "To Err is Human" dramatically exposed the number of deaths due to preventable errors in medical treatment.
But it barely mentioned errors in the diagnostic process.
Part of the problem has been the difficulty of measuring such mistakes.
“The data on diagnostic errors are sparse, few reliable measures exist and often the error is identified only in retrospect,” wrote John R. Ball, chair of the committee and executive vice president emeritus of the AmericanCollege of Physicians.
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Misdiagnosis is more common than drug errors or wrong-site surgery]
The stereotype of one physician considering a patient’s case and coming up with a diagnosis is not always accurate, he said. To fix the problem, he said, "we have to look more broadly at improving the entire process of how a diagnosis is made."
Experts say diagnosis is one of the most difficult and complex tasks in healthcare because it involves patients, clinicians, thousands of lab tests, and more than 10,000 potential diagnoses.
“It crosses so many different domains in the practice of medicine, which makes it complicated by itself,” said Paul Epner, executive vice president of the Society to Improve Diagnosis in Medicine, a nonprofit, physician-led organization patient safety group. The advocacy group petitioned the IOM to produce the report.
Diagnostic errors result from a variety of causes, the committee found. They include inadequate collaboration among clinicians, patients and their families; limited feedback to clinicians about the accuracy of their diagnoses; and a health-care culture that discourages transparency and disclosure of errors.
One example cited in the report was about a woman, identified only as Carolyn, who arrived in the emergency room with chest pain and other classic symptoms of a heart attack. But her tests were normal, and the clinician told her she had acid reflux. A nurse even told her to stop asking questions of the doctor.
The woman was released a few hours later, feeling embarrassed about making a fuss. But over the next two weeks, she became sicker. She returned to the emergency department and clinicians told her she had had a heart attack caused by a blocked artery.
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Medical mysteries: A bad diagnosis]
The report also said that health information technology may be contributing to diagnostic errors. More doctors’ offices and health systems now have electronic health records, but clinicians often complain the systems are hard to use.
Doctors often don’t know when they have made the wrong diagnosis, said Tejal Gandhi, president of the National Patient Safety Foundation, and an internal medicine doctor for 15 years. Often the scenario involves a physician missing something and a patient, who doesn't get better, seeking a second opinion. Something that was missed is picked up, and the first doctor never hears about it, said Kavita Patel, a healthy policy expert at the Brookings Institution's Center for Health Policy and a practicing primary care doctor at Johns Hopkins Medicine.
The report said health-care organizations need to put systems in place to identify diagnostic errors and near misses. They also need to adopt a non-punitive culture so open discussion and feedback can take place. That could be empowering for frontline workers like medical assistants to act as a check and balance, looking for gaps and raising flags, even if it's "something doctors won't like but will appreciate when they avoid a near miss," she said.
Experts say patients can do a lot to help get the right diagnosis. Here is a checklist:
• Be clear, complete and accurate when you tell your clinician about your illness. When did symptoms begin? What made them better or worse? Jot down notes and bring them with you.
• Remember what treatments you've tried in the past, if they helped, and what, if any, side effects you had.
• Keep your own records of test results, referrals and hospital admissions. Keep an accurate list of your medications. Bring the list when you see your clinician or pharmacist.
• Remember to ask your clinician these three questions:
1. What could be causing my problem?
2. What else could it be?
3. When will I get my test results and what should I do to follow up?
