At the age of twelve, I was rushed to the emergency room experiencing severe abdominal pain, nausea, and a high fever of 103 degrees. My father recognized the symptoms of acute appendicitis, a condition he had experienced himself years before. Although my parents made their suspicions clear, they trusted in the doctor’s judgment. I trusted in the doctor’s judgment. After I was given some fluids, a blood test, a routine examination and an abdominal x-ray, my doctor discharged me with a diagnosis of constipation.
Three days later the pain became so unbearable that I could no longer walk and I was again rushed to the ER. I was treated with morphine and given a cat scan only to discover that my appendix had ruptured. Emergency surgery, two weeks of hospitalization, many complications, and a month of recovery later, I was finally ready to resume normal life.
About ten to twenty percent of all medical cases are misdiagnosed, largely exceeding the prevalence of surgical and drug errors. It is estimated that about 40,500 fatal diagnostic errors occur in intensive care units every year and that ten percent of patient deaths result from misdiagnosis. Because so many cases of misdiagnosis and other types of medical malpractice go unreported, it is possible that the prevalence is much higher than estimated. Yet, ninety-six percent of clinicians believe that diagnostic errors are preventable, and they are. Doctors make mistakes, but as a patient, you have the power to protect yourself from medical error. Although patients can self-advocate and involve themselves in their medical care, there is also a need for medical reform to prevent malpractice. The importance of education and safety measures cannot be stressed enough when a patient’s life is at risk.
Patients should be proactive about their care, arming themselves with questions and educating themselves on treatment options and the general course of diagnosis to ensure that their needs are being met. Oftentimes, adequate diagnostic procedure is not followed. While maintaining respect for the physician’s professional opinion is important, it is also necessary that patients advocate for themselves when they know their condition is not being taken seriously. Patients can provide comprehensive medical records, seek second opinions, and insist on further diagnostic testing. Patients should be open and honest when communicating with their doctors and keep records of past test results, medications, and prior health issues. Providing clear medical history and specific symptomology is the first step to reaching the correct diagnosis. Patients should communicate not only with the doctor primarily caring for them, but also other members of the medical team involved. If possible, it can be beneficial for patients to have a primary physician, a doctor who knows their patients well, advocate for them and communicate with specialists to provide further insight into the patient’s case. As a precautionary measure, and especially when the stakes are high, seeking a second or even a third opinion from other specialists is crucial to getting the correct diagnosis. Individual physicians are likely to be biased in the diagnostic process due to their prior experience with seemingly similar cases. Obtaining a pair of fresh eyes to reexamine and evaluate a set of symptoms may present alternative explanations or help to confirm a previous diagnosis.
It is also crucial that patients ask questions and provide input during the diagnostic process. Patients should know their test results and understand what they mean. Rather than accept their health provider’s judgement wholeheartedly, patients should be prepared to double check their physician’s evaluation and discuss possible reasons for their results. The process of discussion could bring attention to problems that the physician may have overlooked. Furthermore, patients should make active decisions about their care and involve family to help advocate for them.
Some of the most commonly misdiagnosed conditions include pneumonia, heart disease, kidney failure, and cancer. Failure to properly diagnose and treat these conditions can be fatal so why do physicians continue to make errors? There are problems with the health care system that need to be addressed. Unlike your primary care doctor, ER doctors or specialists do not know the patients that they treat personally, meaning that they cannot look at a case as comprehensively as they should. Another factor in the increasing prevalence of misdiagnoses is the high patient to doctor ratio. Physicians are overloaded and prone to pay less attention to each individual patient which can lead to negligence. Oftentimes, physicians fail to follow up on testing and miss crucial findings that could have pointed towards the correct diagnosis. A patient-oriented approach to medicine and the availability of universal electronic medical records could help remedy the problem. Although medical error cannot be prevented completely, doctors can help by reporting any errors that they do make. Reporting diagnostic errors should be strongly encouraged to raise awareness of common mistakes and prevent other physicians from repeating those mistakes. Increased monitoring of patient treatment and physician performance should also be instituted in health care facilities to incentivize proper diagnostic measures and provide feedback to improve patient care.
A team-oriented approach that keeps all members of the medical team informed about the patient’s condition could also reduce the prevalence of medical error. For example, different specialists, including radiologists and pathologists should take a more active role in the diagnostic process. Collaboration and feedback from other professionals is critical to making the correct diagnosis because a symptom or test result that one doctor may view as insignificant, another may recognize as abnormal. More collaboration amongst health care professionals could promote reconsideration of other possible diagnoses, providing a safety net for medical error.
So, what could my parents have done, what could I have done, to protect myself from medical malpractice? When the doctor informed us that my white blood cell count was abnormally high, we could have insisted that they investigate further. We could have asked how a diagnosis of constipation could account for a fever. We could have obtained a second opinion to look at my whole set of symptoms more closely, rather than accept a diagnosis based solely on the results of an x-ray. We could have recognized negligence, took more control and advocated for my care more strongly. Although there were problems with the hospital itself, being informed of the prevalence of medical error and the power I had as a patient to protect myself could have prevented the cascade of complications that followed the ER visit. You can avoid my situation, or worse, by being an advocate for yourself and your health.