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Misdiagnosis

by Joel

According to an article in the British Medical Journal called "25-Year summary of US malpractice claims for diagnostic errors 1986–2010: an analysis from the National Practitioner Data Bank" missed, delayed or incorrect diagnoses are the most common causes of harm to patients.

How Common?

In the vignette study Physicians’ Diagnostic Accuracy, Confidence, and Resource Requests in JAMA Internal Medicine, of 118 physicians with broad geographical representation within the United States, the physicians diagnosed only 55.3% of the easy cases correctly. The more difficult cases were diagnosed correctly only 5.8% of the time.

They are wrong more often than they are right

What remained constant was their confidence in the correctness of their diagnoses no matter how frequently they were wrong.

What is important for patients to understand is that in this study the most satisfied patients, the ones who had faith in their doctors and did what they were told, had a 26% higher mortality rate than the patients who were disgruntled and less likely to follow the treatments recommended.

This point keeps being made in different ways without the country managing to gain an awareness of what it means. Like the national study quoted in an article in The Atlantic (links to their site) that found that in hospitals “the most satisfied patients were significantly more likely to die in the next four years." The patients who trust and believe and submit to whatever treatments are recommended die more often.

Treatment Increases Mortality

Treatment brings risk. Incorrect diagnoses bring that risk without a potential benefit. Patients who would have lived without treatment died because they got it.

The patients who don't have faith in their doctors and resign themselves to living with their problems without treating them have a greater likelihood of staying alive.

Medicine is the wrong place for faithMost of the things for which patients seek treatment would resolve themselves without treatment. Many of the rest are mistreated because they are misdiagnosed. Patients who survive somehow usually have faith that they survived because of the treatment, when in fact they would have survived better without it.

I have had injured patients call me complaining that they have been back to doctors 6 or 8 times for attempts to correct the original iatrogenic injury. Each attempt brought additional problems. Now no doctor will touch them. They believe they have been blacklisted.

I have written a lot about blacklisting (for instance this link). I am the last person who would deny that it happens, but sometimes it merely is that the doctors themselves finally see that all they are doing is making the patient worse. It is very difficult to get a patient to learn that same lesson. Their own experience should cause an erosion of the blind faith that is standard for patients. Doctors keep telling patients to trust them and patients keeping believing them. Patients grow up believing that doctors can make them better. No one ever tells them what a bad idea that faith is.Some treatments are worse than the disease

Doctors So Frequently Are Just Wrong

It is not uncommon for the faith patients have in doctors to be so unshakable that when the doctors make them worse time after time, it does nothing to reduce the blindness of their faith in doctors. Sometimes patients even conclude that the doctors must be evil because patients are so certain that the doctors could make them better if they only would.

They Can't

More often than they can, they can't even correctly diagnose the problem. You cannot correctly treat a problem when you cannot correctly identify what it is. Medicine is set up so that everyone, in and out of medicine, remains unaware of the downsides of treatment. It is measured when non-adherence on the part of patients puts them in the ER. But it is not measured when adherence is the cause of injury.

If three out of a hundred non-adherents end up in the ER where they are saved and brought back to health, medicine notices that. If twenty-seven out of a hundred adherents, as a result of adherence, lose jobs or spouses or homes or cause car wrecks with injuries, no one tabulates that. It is assumed that adherence always is in the best interests of patients.

It is not

The failure to be aware of the downsides of treatment results in the medical community having a confidence based on ignorance that takes an enormous, and unrecognized, toll on the patient community.

Prescriptions and other recommended treatments too often either make things worse or at least don’t help. Patients have no choice but to test the difference between following and not following prescribed treatments on themselves. So many others already have walked the same path, but patients do not have access to what they learned. That it is inexcusable. No one in medicine ever will be selfless enough to collect that data objectively for patients. The patient community must create the mechanisms to collect it for itself (for instance, see Community Patient Agency).

Spend some time among the Amish or Mennonites or Christian Scientists who never go to doctors and see how well they do, individually and as a community. I have. They are enviably healthy. More than once I have been through end of life care with one of them. More than once I also have been through end of life care with people who let doctors tell them what to do. Honestly, the difference is whether you get to stay home with your family while you still are able to appreciate them, or let health care professionals hook you up to tubes in a hospital and torture you until you're dead.

When I'm old no one in medicine is getting near me

It is this way, in part, because doctors prescribe for patients treatments that they would not submit to themselves. That is unethical. For instance, the surgeon who earned his living by operating on colon cancer patients, but when he got colon cancer himself did not let anyone operate on him because, as he said, with colon cancer they cut you up and then you die.

He never told that to a patient

And these are the people patients are supposed to trust for guidance? These are the people who are going to bring us transparency?

Patients continually are told to keep in mind that the vast majority of people working in medicine are good people who have only the best interests of patients at heart. The patients who keep that in mind have a higher mortality rate than those who understand the ways in which health care professionals are unethical, self-interested group-thinkers. Rather than falling for slogans advising faith, patients do better when they are wary, skeptical and reluctant to submit to treatment.

Faith is good for doctors
Skepticism is good for patients

Most of the things for which patients seek treatment would heal without it. Yet most appointments with physicians end with a prescription. Most of those create risk with no benefit which increases mortality. Try to find a doctor who understands that. Since you probably cannot, you need to be a patient who does.

We need to go to doctors politely and respectfully, accepting them as though they are selfless fonts of wisdom and help, but realising that they do not know that they are wrong more often than they are right. They do not need to be confronted with the fact that you cannot trust them. But you need to keep in mind that if you do, that is a faith that is blind and for which you will suffer.

See also this link to an article on another site called "Why most doctors like me would rather die than endure the pain of treatment we inflict on others."