Diagnostic errors have gotten less attention from health care critics than medication mistakes or wrong-site surgeries, but they are just as dangerous. Without the right diagnosis, getting the right treatment is a matter of guesswork or luck.
Two renowned patient safety experts say diagnostic errors are far more common than most of us realize, and they offer some ideas for reducing the harm that such serious mistakes can cause. Their commentary, “Diagnostic Errors–The Next Frontier for Patient Safety,” appeared in the Journal of the American Medical Association.
Guests: David Newman-Toker, MD, PhD, Assistant Professor of Neurology at Johns Hopkins University School of Medicine. The photo is of Dr. Newman-Toker.
Peter Pronovost, MD, PhD, Professor in the Department of Anesthesiology and Critical Care at Johns Hopkins University School of Medicine.

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  1. Alejandro
    Reply

    Great show as far as it went. Unfortunately it failed to address the problem of doctors rarely performing PHYSICAL EXAMS. Diagnosis has become too dependent on tests and technology. I highly recommend the new book by Dr. Lisa Sanders called “Every Patient tells a Story”.
    PEOPLE’S PHARMACY RESPONSE:
    Alejandro, hold on for a few weeks. Dr. Lisa Sanders is our guest on The People’s Pharmacy on Sept. 19, 2009. It is show # 740. She is fantastic and the book is great!

  2. Louis H.
    Reply

    What follows is my story of misdiagnosis and medical error. Had the doctor followed standard protocol for testing for compartment syndrome, or had the doctor and hospital staff paid attention to the symptoms, or had the hospital staff been empowered to speak out as was suggested in your radio program, this tragedy may have never happened.
    Three and one half years ago, my son was in an athletic accident and broke both the tibia and the fibula of his left leg. After 30 hours of waiting in emergency room (presumably because the staff thought his injury was a lower priority than others) my son had surgery to repair the broken leg — set the fracture and place a titanium rod in his tibia. My son progressively developed extreme pain in his foot and leg, he lost feeling in his foot and leg, the circulation to his foot was compromised, and his leg was hugely swollen. These symptoms of compartment syndrome were routinely recorded every few hours by hospital staff but were not acted upon.
    After three more days, the surgeon finally tested for compartment syndrome and found that the pressure in my son’s anterior and lateral muscle compartments was 90 mmHg, three times the normal pressure. Due to the trauma, inflammation had increased the amount of fluid in his leg, increasing the pressure to levels that would destroy the muscle, nerves and blood vessels of his leg. The surgeon then did a fasciotomy to relieve the pressure in his leg. Unfortunately, the test for compartment syndrome and the fasciotomy were done so late that my son received permanent damage to his leg.
    Since the initial hospitalization, my son underwent twelve surgeries to remove tissue that had died due to the compartment syndrome. My son underwent numerous painful procedures at home to keep the open wound as healthy as possible and to promote healing. Eventually, he had reconstructive surgery to close the open wound with a skin graft from his right thigh and a muscle transplant from his abdomen.
    Over time condition of my son’s leg deteriorated: he had more and more pain, more complications and less mobility. This has led to his decision to have his lower leg amputated which was just completed this month.

  3. Raine
    Reply

    Thank you for some attention to this subject. My younger brother died of metastasized lung or bone cancer on April 4 this year, at 48 years old. He’d gone to his doctor in Jan. ’08. complaining of rib pain. His doctor suggested he ‘take it easy’ for a few weeks, as it was probably a job-related injury (he was an auto mechanic). He did, and the pain got worse. When he returned to his doctor, requesting an MRI, the doctor refused, sticking to his diagnosis. My brother called his insurance company and to their credit, they ordered an MRI. Diagnosis: widespread cancer in his lungs, metastasized to his bones and lymph nodes. He began chemo. and radiation in October, 2008, became sicker, and finally died with severe pneumonia and disintegrated discs in his back due to the cancer. He was the sole support of his family, his wife, a 14-year-old daughter and an angry 10-year-old son. No life insurance (who dies at 48 of cancer? He was very healthy and fit).
    His doctor could have ordered an MRI to rule out something else, like cancer. He made a mistake in not doing so. Would Matt have survived with earlier diagnosis of cancer? Who knows?
    Thank you for your work. I’m married to a doctor and know that doctors are not perfect or make perfect judgments every time. I can’t blame the doctor, but I wish he’d been more cautious.

  4. jkh
    Reply

    I have a son who became a doctor. He graduated from Dartmouth pre-med in the top quarter of his class. He couldn’t go to the first two years of med school in the US because he did not have an MD to reccomend him. He went to France, learned French over the summer, and did well eough to be accepted by a US school for the final two. This was in the ’70s. He explained to me later, that in the French system, the final two were for specialization. One of the specialties was diagnosis. Only diagnosticians had their own office and staff. The speciaties were all salaried hospital staff. Seems like that would be a far less expensive alternative. How many bookkeepers do you need submitting claims?

  5. Sally Kochendofer, PhD
    Reply

    How helpful it would be to have simply posted those few questions that patients could/should ask their doctor, e.g., how confident are you about this diagnosis? what else could it be? etc.

  6. BJO
    Reply

    Thank you very much for your informative program on physician errors and pt./dr communication today. It verifies the concerns of patients who consult physicians and are frustrated by the inability to communicate with them about their concerns, either because the physician is rushed or disinterested.
    This discussion needs to be continued in an effort to reduce physicians’ errors in diagnosis and improve doctor/pt. relationships to promote healing and wellness. Good medical care involves much more than ordering tests, reading graphs and charts, and writing a prescription, as important to medical care as these are. It is heartening to read doctors’ works expressing their own concerns about patient care and medical errors, including the JAMA article cited in the program.
    All practicing physicians would benefit from reading Dr. Jerome Groopman’s HOW DOCTORS THINK (to bring fresh perspectives to their own practice of medicine) and Atul Gawande’s articles in THE NEW YORKER or his books: BETTER: A SURGEON’S NOTES ON PERFORMANCE and an earlier tome, COMPLICATIONS: A SURGEON’S NOTES ON AN IMPERFECT SCIENCE. (His discussions go well beyond the practice of surgery.
    It is clear that our health-care system compromises optimal medical care, but the issues of medical error and dr./pt. communication need to be addressed by ALL physicians. Incidentally, there did not seem to be an attack on any medical specialty in the program rather helpful approaches to communicating with busy physicians in more effective ways was emphasized. Keep up the good work! Let’s have more programs on today’s topics.

  7. Paula T.
    Reply

    I had a misdiagnosis on a detaching retina. The doctor’s comment on my visit concerning light flashes that I was experiencing was that it was nothing to be concerned about. He said that if it was a detaching retina, it would look like a curtain coming down over the sight in your eye.
    A few weeks later, I experienced a dark patch rising from the bottom of my eye. I was confused by this and thought it was something in my eye. At this time I was a artist-in-resident in Cortona, Italy and I had to go to Arezzo to an Ophthalmologist. He diagnosed a detaching and torn retina. He sent me to a hospital in Siena.
    I spent 8 days and a schleral buckling operation to restore my eyesight. I also have glaucoma and nerve damage in this eye as a result. I am an artist and recorded all the stages of this problem in drawings and paintings because I could document it accurately since I am a artist. They are now with Dr. Ching J. Chen at the University of Mississippi Medical School in Jackson, Mississippi. He displays these images and considers it a diagnostic tool for detecting a detaching retina. Many other doctors are still telling their patients that this disease is like a curtain coming down and it is not.
    These images are now in the Intellectual Property Program at the University of Mississippi, Oxford/University campus.
    Paula Temple, Professor of Art, University of Mississippi

  8. cb
    Reply

    As a primary care physician, I take exception to the accusatory and derogatory discussion about medical errors by two specialists who, in general, have much more REIMBURSED time with which to interact with patients than do PCP’s. You dumped on doctors with the frontline primary care doctor being the “dummy doctor” by implication. It is no wonder that fewer and fewer students are going into primary care with hyperbole and innueno that you throw out in the name of an objective discussion. You need a primary care physician to counterbalance your foolish tendencies.

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