MEDICAL MISSED & MIS-DIAGNOSIS

What to do if you are feel you are Mis-diagnosed?

What I tell patients. What I teach doctors

A medical misdiagnosis can have life-or-death consequences.
Misdiagnosis is one of the primary reasons why medical malpractice cases are filed.
A misdiagnosis can occur when a doctor fails to correctly diagnosis a patient's injury or ailment, delays diagnosis or fails to provide any diagnosis at all, resulting in harm or even death. Studies show that diagnostic errors occur in 10-30% of all medical cases.

While some of these errors may eventually be caught and cause no harm to the patient, this is not true in all cases. Unfortunately, not all doctors have the same experience, training and knowledge, and medical errors can happen. We trust doctors to provide accurate information regarding our health. Many of us feel intimidated by doctors and are reluctant to question their opinions. Few of us have the necessary training or knowledge to determine if a misdiagnosis has occurred.

Diagnostic Errors As A Source Of Dissatisfaction And Malpractice Suits

A total of 181 claims (59%) involved diagnostic errors that harmed patients were reviewed. Fifty-nine percent (106 of 181) of these errors were associated with serious harm, and 30% (55 of 181) resulted in death.
For 59% (106 of 181) of the errors, cancer was the diagnosis involved, chiefly breast (44 claims [24%]) and colorectal (13 claims [7%]) cancer.
The most common breakdowns in the diagnostic process were

i. failure to order an appropriate diagnostic test (100 of 181 [55%]),
ii. failure to create a proper follow-up plan (81 of 181 [45%]),
iii. failure to obtain an adequate history or perform an adequate physical examination (76 of 181 [42%]), and
iv. incorrect interpretation of diagnostic tests (67 of 181 [37%]).

The leading factors that contributed to the errors were

v. failures in judgment (143 of 181 [79%]), vigilance or memory (106 of 181 [59%]),
vi. knowledge (86 of 181 [48%]),
vii. patient-related factors (84 of 181 [46%]), and
viii. handoffs (36 of 181 [20%])

Diagnostic errors that harm patients are thus typically the result of multiple breakdowns and individual and system factors.

What Should You –The Patient--Do if You Believe You Have Been Misdiagnosed?

1. Trust your instincts. Don't assume everything will be fine.
2. If you feel that something is wrong or if you believe the diagnosis doesn't fit your symptoms, go back to your doctor.
3. If you feel your treating physician just isn't listening to you, or is wrong, then seek a second opinion or ask for a referral to a specialist. The important thing is to take action.

4. If you aren't improving or you suspect that something else is wrong, do not sit around and wait for it to get better -- even if your doctor is telling you to do just that.
5. Ask for and/or get a second opinion on your own.
6. If one is not forthcoming from your doctor call the nearest University teaching hospital and ask the medical director for an appointment with a specialist on the medical staff involving your organ system e.g. Gastroenterology for stomach and intestinal problems; Nephrology for kidney problems etc. Once seen by the specialist you will be “plugged into the system” for a more detailed evaluation.

What Can You Do to Prevent Misdiagnosis?

While doctors play the ultimate role in determining the diagnosis of a patient's illness or injury, you can prevent or lessen the chance of misdiagnosis by following some simple rules.
o Don't be afraid to talk to your doctor.
o It is vital that you provide your physician with as much information as possible about your condition, symptoms and medical history.
o Communicate this information clearly to your doctor and provide concise, detailed descriptions.
o Never assume any small detail is not important.
o If you have a question, ask it. If you do not understand what your doctor is telling you, ask for a clarification. Make the doctor explain until you understand. If you have questions about your treatment options, medications, or anything else, ask them.

o This is your health, and you have the right to understand what is going on.
o You should also ask the doctor what other possible diagnosis there could be for your ailment so you have as much information as possible about your condition.

Sometimes I see patients in my office who tell me before I examine them what their diagnosis is from Internet research they performed prior to seeing me.
In only a few cases are they correct.

Patients, should not attempt to self-diagnose.

Internet research should be used to help you understand your condition and become better prepared to ask your doctor questions or request a second opinion rather that prejudge what the doctor will find upon history and examination.

Gandhi T.K. et al “Missed and Delayed Diagnoses in the Ambulatory Setting: A Study of Closed Malpractice Claims”Annals Internal Med;2006.145[7]:488

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