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Thursday, September 27, 2007

Misdiagosis and No Diagnosis All Too Common

I've mentioned recently that a doctor I know told me that " there is no diagnosis. Everything is based on labs".

To a great extent this is very true, and it is something I have been confronted with by clients for many years.

Recently I had a phone call from a client who was extremely short of breath, what we refer to as SOB. Probably the most common cause of SOB is congestive heart failure or some type of serious cardiovascular event.

I could tell by speaking with this person it was not allergy, yet this is where my effort to get her to go to the doctor led.

In this person's case the student PA at her clinic (for low income and those with little or no insurance) gave her somethings for allergy.

It was later on, because of her co-workers that she went to the ER where it was determined she had congestive heart failure.

I reviewed all the lab work from the ER and found that neither the clinic or the ER had ordered a CBC with diff, lipid or chemistry panel. The only lab tests were for some of the common cardiovascular indicators. When I finally had all the lab work, using the biochemistry related method I use to determine deficiencies, it was fairly clear what the risks were.

So it is not just the lab work, but it is the best analysis of the lab work that counts too.

With an echocardiogram it was determined that her heart valve was quite damaged.

Still her clinic was doing little to get her a referral to a cardiologist. When this finally came about the doctor was verbally demeaning to this client because she was using natural therapies.

Mind you this arrogant doctor was working in a Western Washington medical group that advertises on its web site that the patient comes first and their wishes are paramount.

As yet, her clinic - the one who is prescribing her diuretic and ACE inhibitor - also did not want to respond to her obvious reaction to a drug they prescribed and has not provided follow-up care as is required since they are prescribing medications.

As it says in our banner, our goal is, and has been for decades, to give more tools to both patients and health care providers to get to the real cause and work collaboratively as a team for the best interest of patient care.

I guess I may be a step or two ahead of CNN, but at least they are trying.

Wish more in health care did too.
By Elizabeth Cohen, CNN

Empowered Patient is a regular feature from CNN Medical News correspondent Elizabeth Cohen that helps put you in the driver's seat when it comes to health care.

ATLANTA, Georgia -- The celebrity was John Ritter.

Actor John Ritter died in September 2003 from an aortic dissection, a commonly misdiagnosed condition.

The actor died in 2003 of an aortic dissection -- a tearing of the major artery that comes out of the heart. His widow later settled a wrongful death lawsuit against a California hospital, alleging his condition had been misdiagnosed "at least twice."

Experts who study malpractice cases and autopsy reports say certain diseases are misdiagnosed over and over again. It's worth knowing what they are so you won't be a victim.

1. Aortic dissection: Sometimes aortic dissections are easy to diagnose -- a patient feels a distinct tearing sensation in his or her chest. But other times they're pretty easy to miss because the symptoms could point to other diseases, says Dr. Robert Bonow, past president of the American Heart Association. "Sometimes it feels like heartburn," he says.

2. Cancer: In a Harvard study of malpractice claims in the U.S., cancer was far and away the most misdiagnosed illness, primarily breast and colorectal. Study authors attributed this to doctors failing to stick to cancer screening guidelines.

3. Clogged arteries: Sometimes doctors tell patients they're short of breath because they're out of shape, when it's actually coronary artery disease, says Bonow, who's also the chief of cardiology at Northwestern Medical School.

4. Heart attack: Sound strange? How could a doctor miss a heart attack? Bonow says the big and obvious attack -- the one where someone clutches his or her chest and falls to the floor, the one Bonow calls "the Hollywood heart attack" -- isn't always so clear. Sometimes the only signs of a heart attack are a sense of fullness in the chest, nausea and a general sense of not feeling well.

5. Infection: In the Harvard study, infection followed cancer as the most misdiagnosed condition.

So how can you keep yourself from becoming a victim of misdiagnosis?

1. Ask for more tests - Has your illness been misdiagnosed? - Actually, Nancy Keelan says, demand more tests. For more than three years, Keelan says, she complained to her gynecologist about irregular, heavy bleeding, and for three years he told her she was entering menopause and not to worry. Keelan says it turned out she had both advanced endometrial and ovarian cancer. "I believe he missed my diagnosis five times," says Keelan, who was 46 when she got her correct diagnosis.

Keelan, a registered nurse, now speaks to women's groups, telling them not to let more than three weeks go by if they're having new, strange symptoms. She says if the doctor tells you it's no big deal, you can frame your request this way: Tell your doctor you know it might be nothing, but would it do any harm to have a simple test? She says a simple ultrasound, would have caught her cancer much earlier.

2. Ask, "What else could my illness be?" - Let's say you've been experiencing shortness of breath when you exercise, and your doctor tells you you're just out of shape. You can ask your doctor if it could possibly be something more dangerous. Dr. Mark Graber, chief of medicine at the Veteran's Administration in Northpoint, New York, says the single most common cause of misdiagnosis is a doctor's failure to consider other possibilities after an initial diagnosis is reached. "It's called premature closing -- the minute they come up with a diagnosis, they don't think about a better solution," he says.

3. Don't assume no news is good news - Another source of misdiagnosis: Lab results get lost or forgotten. A study by Dr. Tejal Gandhi at Harvard Medical School found that up to 33 percent of physicians did not always notify patients about abnormal test results. "No news is not good news," says Dr. Saul Weingart, vice president for patient safety at Dana Farber Cancer Institute. "It might be that the report fell down behind someone's desk."

4. Assume your doctors don't talk to one another - Our experts said doctors often don't share information about test results. One piece of advice: Use that conference call function on your cell phone. Make phone appointments with your doctors at the same time, and then conference them all together.

5. Be wary when your doctors work in shifts - The title of Gandhi's 2005 study in the Annals of Internal Medicine says it all: "Fumbled Handoffs: One Dropped Ball after Another." In it, she describes how a hospital patient's tuberculosis was misdiagnosed partly because test results weren't passed on when doctors changed shifts.

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