I was surfing through some medical blogs the other day and found this Emergency Physicians Monthly - White Coats Call Room – A blog from inside the emergency department http://www.epmonthly.com:80
The doctor writes that “During a recent ED shift, just for the heck of it, I started taking notes as I went from room to room treating patients. I wanted to try to show myself whether or not “defensive medicine” was a figment of my imagination. It isn’t a figment of my imagination.”The ED doctor gives these examples which do not serve his purpose of showing up “defensive medicine as bad.” In fact if f I were judging by this doctor’s examples I would defend the indefensible. I would defend defensive medicine.
See if you agree.
His Example 1.
A patient in her 60s fell and hit her head 5 days ago. She was having a headache. I couldn’t find a mark on her and was inclined to send her home with pain medications. But she was on Coumadin which put her at risk of bleeding. So I did a CT scan of her head to “make sure” that she didn’t have a bleed. She didn’t.
But she could have! Couldn’t she? Remember the late Catherine Graham owner of the Washington Post who died post fall cerebral bleed. And how about the beautiful actress daughter of the famous Redgrave clan - Natasha Richardson--mother of 2 children who also died post a skiing accident of a subdural hematoma—even without Coumadin to precipitate and prolong the bleeding inside her head.. The only way to help these patients is early diagnosis by x-ray. When clinical findings occur it’s usually too late-- which this doctor, seems to disregard.
Example 2 given by this ED doctor as defensive medicine.
An out of town patient in her 40’s who had a long history of smoking and a history of COPD came in for coughing and shortness of breath. She was at a baby shower and had forgotten her albuterol inhaler. Her oxygen saturation was 92% on room air. Her heart rate was 105. She got a couple of treatments and steroids and was marginally improved. Her symptoms were most likely explained by her underlying COPD. I was inclined to discharge her with a prescription for steroids and another inhaler. Instead, I did a CT scan of her chest to “make sure” that she didn’t have a pulmonary embolism. She didn’t. She went home on steroids and an inhaler. We made sure to recommend that she stop smoking so that we wouldn’t get dinged by CMS for failing to meet a “quality indicator.”
This patient could very well have a pulmonary embolus kicking in a bout of SOB.
His third Example.
A patient dropped a TV on his foot. There was only a little red mark on the back of his foot, but the patient stated that he could not bear weight on his foot. I was inclined to wrap him up and send him home with pain medication and crutches, but I did an x-ray of his foot to “make sure” that there was no fracture. There wasn’t.
Only a little red mark of his foot-but he could not bear weight on his foot? Sounds like an x-ray certainly is indicated here.
Example 4.
A 94 year old demented lady was brought in because she was not “acting right.” Her daughter tried to wake her from sleep and had a more difficult time than usual waking the patient up. The daughter stated that the patient was “acting different,” even though nurses who had seen the patient before and the nursing home staff stated that the patient was not acting different. The patient got a bunch of labs and a head CT just to “make sure” that the allegedly incremental increase in her dementia wasn’t caused by a metabolic problem or a spontaneous bleed in her brain. It wasn’t. She was discharged back to the nursing home to finish her nap.
The most common causes of sudden dementia or worsening of dementia in the elderly are medication problems, metabolic causes and infections. This lady certainly deserved these “defensive medical tests.”
Example 5.
Then there was the suicidal patient. She was drinking, became upset with her boyfriend, and used a piece of broken glass to cut her wrists. Her alcohol level was in the mid-200s. She was drunk and she “was going to f***ing die.” But no psychiatric institution would accept her in transfer until she had a complete laboratory and toxicological workup, including an EKG and a urinalysis just to “make sure” that a whacked out chloride level or a raging UTI wasn’t really behind her suicidal tendencies.
That’s right. How many “psychiatric” patients die in the psychiatric unit not from psychiatric but because of drugs and metabolic causes? Too many.
This particular ED doctor obvious from his remarks, thought that he had to do all the “extra” studies because of “defensive medicine.”
“Why,” he asks, “was I ordering all of these things when my clinical judgment led me to believe that they would “probably” not lead to any changes in the patient’s management?
Hello! Clinical judgment is great where indicated. These examples however do not prove this doctor’s point. In fact the opposite.
The answer, he gives is that “because in our culture, “probably” doesn’t cut the mustard any more. Clinical medical judgment has been supplanted, he says, by the demand that physicians disprove the improbable. Society has made it so that physicians are more concerned with proving that unlikely diagnoses with the possibility of a “bad outcome” don’t exist and with maintaining good Press - Ganey scores. Many physicians are afraid to practice rational medicine based upon clinical judgment and physical examination skills. No one wants to face the liability. For those who would assert that I was practicing inappropriate medicine for ordering all of the “unnecessary tests” above, tell me which conditions that it would have been acceptable to “fail to diagnose” on the possibility that my clinical examination alone missed an unlikely disease process. That, my friends, is defensive medicine at work.”
Doctor, your case would be better made with better examples.
And doctor, I would further reply ---how about this case?
40 yr old indigent street guppy shows up to the ER with altered level of consciousness. Blood alcohol was .3 (almost 4 times the normal intoxication limit 0.08). ER Doc runs CBC, metabolic panel that shows only elevated liver enzymes, no surprise for chronic alcoholism. ER Doc decides to wait it out, and discharges patient after almost a full shift, alert and oriented. (No discharge blood alcohol done). Said patient returns 1 hr later, again altered LOC. Being a bounce back, this time he gets the full work-up. Blood alcohol 0.12, CT shows subdural hematoma.
What really is defensive medicine? Defensive medicine eludes easy definition
Definitions include:
“Medical practices designed to avert the future possibility of malpractice suits.”
“ In defensive medicine, responses are undertaken primarily to avoid liability rather than to benefit the patient.”
“Doctors order tests, procedures, or visits, or avoid high-risk patients or procedures primarily (but not necessarily solely) to reduce their exposure to malpractice liability.”
“Medical practices designed to avert the future possibility of malpractice suits.”
Some defensive medicine, however, presumably helps patients. Some paradoxically puts the patients in harm's way (the more you do, the more you are likely to "break something.")
As the blog complained, many believe that sound clinical judgment has been supplanted by disproving the improbable. Failure to diagnose, no matter how improbable, can, and often does, evolve into a multi-year odyssey narrated by "a plaintiff's attorney telling everyone how the patient's injury is an example of why [the physician] is a bad doctor and why clinical examination alone is simply not good enough." But the problem with the definitions are that defensive” medicine - ie medicine done to avoid the risk of liability, remains undefinable, because you don’t know if your liability is actually reduced by each “unnecessary” test you order.
COMMENT:
If I were judging by this doctor’s examples I would defend the indefensible. I would defend defensive medicine.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
* Tune in tomorrow for TOP 10 Laws and Rules Every Physician Should Know
Deepen your understanding of How to Be an Effective Medical Expert www.medmalbook.com
Showing posts with label diagnosis. Show all posts
Showing posts with label diagnosis. Show all posts
Sunday, June 28, 2009
Saturday, June 13, 2009
ADRENAL INCIDENTALOMAS
In medicine, an incidentaloma is a tumor (-oma) found by coincidence (incidental) without clinical symptoms or suspicion. It is a common problem with the current rate of imaging and is the name given to a lesion found by accident when doing x-rays or other imaging procedures for something else. These lesions or masses are found on the adrenal gland which sits on top of the kidney.
Up to 7% of all patients over 60 may harbor a benign growth, often of the adrenal gland, which is detected when diagnostic imaging is used for the analysis of unrelated symptoms. With the increase of "whole-body CT scanning" as part of health screening programs, the chance of finding incidentalomas is expected to increase. 37% of patients receiving whole-body CT scan may have abnormal findings that need further evaluation.
When faced with an unexpected finding on diagnostic imaging, the clinician faces the challenge to prove that the lesion is indeed harmless. Other tests are required to determine the exact nature of an incidentaloma.
What are the facts about adrenal masses discovered during imaging for non-adrenal related causes?
• It is the commonest adrenal 'disorder'
• Found during 1-5% of abdominal CT scans
• 5-10% patients have non-functioning adrenal masses found at postmortem examination
• Male to female ratio is equal
• Most incidentalomas are benign and hormonally inactive
• Few patients require adrenalectomy
• Diagnostic assessment needs to evaluate:
o Is the lesion hormonally active
o Is the lesion malignant
Tom Cawood states that evaluation of adrenal incidentalomas is costly, has high false positive rates and confers a risk of fatal cancer that is similar to the risk of the adrenal lesion becoming malignant and it’s time for a re-think of the whole matter. Cawood suggests that we-re-assess the performance of current clinical recommendations for the evaluation of an adrenal incidentaloma.
Cawood performed a literature review of electronic databases (Pubmed, Ovid and citation searches from key articles) from 1980 to 2008. Eligible studies were those deemed most applicable to the clinical scenario of a patient referred to an endocrinologist for assessment of an incidentally detected adrenal mass. Surgical series, histopathological series and oncological series were reviewed and most were excluded.
Results:
• The prevalence of functional and malignant lesions presenting as adrenal incidentaloma was similar to that quoted in most reviews, other than a lower incidence of adrenal carcinoma (1.9% vs 4.7%) and metastases (0.7% vs 2.3%).
• The development of functionality or malignancy during follow-up was rare (<1% style="font-weight: bold;">Bottom Line:
This argues for a review of current guidelines.
Current recommendations for evaluation of adrenal incidentaloma are likely to result in significant cost, both financial and emotional, due to high false-positive rates.
The dose of radiation involved in currently recommended CT scan follow-up confers a risk of fatal cancer that is similar to the risk of the adrenal becoming malignant.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Up to 7% of all patients over 60 may harbor a benign growth, often of the adrenal gland, which is detected when diagnostic imaging is used for the analysis of unrelated symptoms. With the increase of "whole-body CT scanning" as part of health screening programs, the chance of finding incidentalomas is expected to increase. 37% of patients receiving whole-body CT scan may have abnormal findings that need further evaluation.
When faced with an unexpected finding on diagnostic imaging, the clinician faces the challenge to prove that the lesion is indeed harmless. Other tests are required to determine the exact nature of an incidentaloma.
What are the facts about adrenal masses discovered during imaging for non-adrenal related causes?
• It is the commonest adrenal 'disorder'
• Found during 1-5% of abdominal CT scans
• 5-10% patients have non-functioning adrenal masses found at postmortem examination
• Male to female ratio is equal
• Most incidentalomas are benign and hormonally inactive
• Few patients require adrenalectomy
• Diagnostic assessment needs to evaluate:
o Is the lesion hormonally active
o Is the lesion malignant
Tom Cawood states that evaluation of adrenal incidentalomas is costly, has high false positive rates and confers a risk of fatal cancer that is similar to the risk of the adrenal lesion becoming malignant and it’s time for a re-think of the whole matter. Cawood suggests that we-re-assess the performance of current clinical recommendations for the evaluation of an adrenal incidentaloma.
Cawood performed a literature review of electronic databases (Pubmed, Ovid and citation searches from key articles) from 1980 to 2008. Eligible studies were those deemed most applicable to the clinical scenario of a patient referred to an endocrinologist for assessment of an incidentally detected adrenal mass. Surgical series, histopathological series and oncological series were reviewed and most were excluded.
Results:
• The prevalence of functional and malignant lesions presenting as adrenal incidentaloma was similar to that quoted in most reviews, other than a lower incidence of adrenal carcinoma (1.9% vs 4.7%) and metastases (0.7% vs 2.3%).
• The development of functionality or malignancy during follow-up was rare (<1% style="font-weight: bold;">Bottom Line:
This argues for a review of current guidelines.
Current recommendations for evaluation of adrenal incidentaloma are likely to result in significant cost, both financial and emotional, due to high false-positive rates.
The dose of radiation involved in currently recommended CT scan follow-up confers a risk of fatal cancer that is similar to the risk of the adrenal becoming malignant.
Please remember, as with all our articles we provide information, not medical advice.
For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.
Sunday, June 7, 2009
“QUALITY METRICS” IS NOW BECOMING THE STANDARD OF MEDICAL CARE
The Obama administration is working with Congress to mandate that all Medicare payments be tied to "quality metrics." But an analysis of this drive for better health care reveals a fundamental flaw in how quality is defined and metrics applied. In too many cases, the quality measures have been hastily adopted, only to be proven wrong and even detrimental to the patient.
In Massachusetts, there are not only carrots but also sticks to adhere to quality metrics. Physicians who fail to comply with quality guidelines from certain state-based insurers are publicly discredited and their patients required to pay up to three times as much out of pocket to see them. Unfortunately, many states are considering the Massachusetts model for their local insurance.
A colleague who works in an ICU in a medical center in our state told us how his care of the critically ill is closely monitored. If his patients have blood sugars that rise above the metric, he must attend what he calls "re-education sessions" where he is pointedly lectured on the need to adhere to the rule. If he does not strictly comply, his hospital will be downgraded on its quality rating and risks financial loss. His status on the faculty is also at risk should he be seen as delivering low-quality care.
But this coercive approach was turned on its head last month when the New England Journal of Medicine published a randomized study, by the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Canadian Critical Care Trials Group, of more than 6,000 critically ill patients in the ICU. Half of the patients received insulin to tightly maintain their sugar in the normal range, and the other half were on a more flexible protocol, allowing higher sugar levels. More patients died in the tightly regulated group than those cared for with the flexible protocol.
Similarly, maintaining normal blood sugar in ambulatory diabetics with vascular problems has been a key quality metric in assessing physician performance. Yet largely due to two extensive studies published in the June 2008 issue of the New England Journal of Medicine, this is now in serious doubt.
Indeed, in one study of more than 10,000 ambulatory diabetics with cardiovascular diseases conducted by a group of Canadian and American researchers (the "ACCORD" study) so many diabetics died in the group where sugar was tightly regulated that the researchers discontinued the trial 17 months before its scheduled end.
And just last month, another clinical trial contradicted the expert consensus guidelines that patients with kidney failure on dialysis should be given statin drugs to prevent heart attack and stroke.
These and other recent examples show why rigid and punitive rules to broadly standardize care for all patients often break down.
Doubts about the relevance of quality metrics to clinical reality are even emerging from the federal pilot programs launched in 2003. An analysis of Medicare pay-for-performance for hip and knee replacement by orthopedic surgeons at 260 hospitals in 38 states published in the most recent March/April issue of Health Affairs showed that conforming to or deviating from expert quality metrics had no relationship to the actual complications or clinical outcomes of the patients.
Similarly, a study led by UCLA researchers of over 5,000 patients at 91 hospitals published in 2007 in the Journal of the American Medical Association found that the application of most federal quality process measures did not change mortality from heart failure.
Live interview Monday, June 8th 11AM, ET with Sybil Tonkonogy on WNTN (AM 1550), Newton, MA. Interview will also air live on radio's web site, http://www.wntn.com
In Massachusetts, there are not only carrots but also sticks to adhere to quality metrics. Physicians who fail to comply with quality guidelines from certain state-based insurers are publicly discredited and their patients required to pay up to three times as much out of pocket to see them. Unfortunately, many states are considering the Massachusetts model for their local insurance.
A colleague who works in an ICU in a medical center in our state told us how his care of the critically ill is closely monitored. If his patients have blood sugars that rise above the metric, he must attend what he calls "re-education sessions" where he is pointedly lectured on the need to adhere to the rule. If he does not strictly comply, his hospital will be downgraded on its quality rating and risks financial loss. His status on the faculty is also at risk should he be seen as delivering low-quality care.
But this coercive approach was turned on its head last month when the New England Journal of Medicine published a randomized study, by the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Canadian Critical Care Trials Group, of more than 6,000 critically ill patients in the ICU. Half of the patients received insulin to tightly maintain their sugar in the normal range, and the other half were on a more flexible protocol, allowing higher sugar levels. More patients died in the tightly regulated group than those cared for with the flexible protocol.
Similarly, maintaining normal blood sugar in ambulatory diabetics with vascular problems has been a key quality metric in assessing physician performance. Yet largely due to two extensive studies published in the June 2008 issue of the New England Journal of Medicine, this is now in serious doubt.
Indeed, in one study of more than 10,000 ambulatory diabetics with cardiovascular diseases conducted by a group of Canadian and American researchers (the "ACCORD" study) so many diabetics died in the group where sugar was tightly regulated that the researchers discontinued the trial 17 months before its scheduled end.
And just last month, another clinical trial contradicted the expert consensus guidelines that patients with kidney failure on dialysis should be given statin drugs to prevent heart attack and stroke.
These and other recent examples show why rigid and punitive rules to broadly standardize care for all patients often break down.
Doubts about the relevance of quality metrics to clinical reality are even emerging from the federal pilot programs launched in 2003. An analysis of Medicare pay-for-performance for hip and knee replacement by orthopedic surgeons at 260 hospitals in 38 states published in the most recent March/April issue of Health Affairs showed that conforming to or deviating from expert quality metrics had no relationship to the actual complications or clinical outcomes of the patients.
Similarly, a study led by UCLA researchers of over 5,000 patients at 91 hospitals published in 2007 in the Journal of the American Medical Association found that the application of most federal quality process measures did not change mortality from heart failure.
Live interview Monday, June 8th 11AM, ET with Sybil Tonkonogy on WNTN (AM 1550), Newton, MA. Interview will also air live on radio's web site, http://www.wntn.com
Tuesday, June 2, 2009
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
Book I - “Medical Malpractice Expert Witnessing: Introductory Guide for Physicians and Medical Professionals” (Hardcover) by Perry Hookman, MD (Author) : 592 pages.27 chapters. Publisher: CRC; Potomac Press; Language: English ISBN-10: 1420058959 ISBN-13: 978-1420058956; Dimensions: 10.1 x 7.1 x 1.4 inches; Shipping Weight: 2.6 pounds; price $239.95.
For author information visit www.Hookman.com; for book purchase visit www.MedMalBook.com
Book II –“Medical Expert Testimony: Advanced Syllabus for Physicians and Medical Professionals”
(Hardcover) by Perry Hookman MD (Author) 32 chapters; 936 pages. Proj.Pub date Spring 2009. Publisher: Potomac Press-CRC; ; Language: English ISBN: 978-0-9817570-0-1; ISBN:10:0-9817570-0-6 - Barcode (9780981757001.eps) Dimensions: 10.1 x 7.1 x 2.1 inches; Shipping Weight: 3.0 pounds; Price $289.95; includes CD-ROM. For author information visit www.Hookman.com; for book purchase visit www.MedMalBook.com
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
Book I - “Medical Malpractice Expert Witnessing: Introductory Guide for Physicians and Medical Professionals” (Hardcover) by Perry Hookman, MD (Author) : 592 pages.27 chapters. Publisher: CRC; Potomac Press; Language: English ISBN-10: 1420058959 ISBN-13: 978-1420058956; Dimensions: 10.1 x 7.1 x 1.4 inches; Shipping Weight: 2.6 pounds; price $239.95.
For author information visit www.Hookman.com; for book purchase visit www.MedMalBook.com
Book II –“Medical Expert Testimony: Advanced Syllabus for Physicians and Medical Professionals”
(Hardcover) by Perry Hookman MD (Author) 32 chapters; 936 pages. Proj.Pub date Spring 2009. Publisher: Potomac Press-CRC; ; Language: English ISBN: 978-0-9817570-0-1; ISBN:10:0-9817570-0-6 - Barcode (9780981757001.eps) Dimensions: 10.1 x 7.1 x 2.1 inches; Shipping Weight: 3.0 pounds; Price $289.95; includes CD-ROM. For author information visit www.Hookman.com; for book purchase visit www.MedMalBook.com
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