Misdiagnosis: who is to blame and what to do

How to deal with incorrect diagnoses?

Dmitry Tselikov, Compulenta

We should start by recognizing this problem and creating a space for discussion by all interested parties. Not only doctors are sinful, but the entire healthcare system is flawed.

Most will agree that the correct diagnosis is very important. Will the doctors agree? Absolutely! Patients? As one! Everyone else? Of course!

But for some reason, there is still no such organization that would deal with the problem of medical errors and keep relevant statistics.

Estimates by eye, of course, are. Mark Graber from the non-profit research organization RTI and the State University of New York (USA) gives the following figures: incorrect diagnoses are made in 10-15% of cases. For example, in Australia, this is expressed in about 140 thousand errors per year, and in 21 thousand cases, great harm is done to patients. 2-4 thousand people die from this. And surveys show that an incorrect diagnosis is one of the most terrible fears of a person crossing the threshold of a medical institution. In the United States, accusations of misdiagnosis account for the largest share of lawsuits concerning medical errors.

All this is more than enough to take care of the issue at the state and even international level, but who is still there. According to Mr. Graber, the reason for the delays is the lack of consensus on who should be responsible for the incorrect diagnosis and who will decide whether the diagnosis is correct or not.

First of all, it is necessary to recognize that it is often very difficult to make a diagnosis, because the same disease can manifest itself differently in different people. Besides, it's simply impossible to know everything about medicine. According to the World Health Organization, there are over 12 thousand diseases. Have you ever heard of yellow nail syndrome or alien hand syndrome? Most likely, your district police officer also has no idea about it. In addition, new ailments are constantly being registered.

Further: the healthcare system itself is far from perfect. Any specialist looks at the body from his bell tower (come to the oculist with watery eyes, and he will find you have conjunctivitis, whereas you are allergic to pollen, and an otorhinolaryngologist easily mistakes asthma for tonsillitis or bronchitis), and patients are confused in the indications.

In other words, an incorrect diagnosis can be the result of reasons that depend not on doctors, but on those people who, relying on the achievements of medicine (I really hope that they really rely on them), think over the health care system and the education of health workers at all levels.

The second group of reasons is directly related to doctors – with their experience and competence, with their conscientiousness, intelligence and the mood with which they allowed themselves to come to work. Mr. Graber notes that 80% of cognitive errors doctors make as a result of incorrect synthesis of all available information about the patient.

For example, very often a doctor, due to banal human weaknesses, does not want to look at the situation differently and trusts the opinion of specialists who dealt with the patient before him. Recently, because of this, 12-year-old American Rory Staunton was sent home with a diagnosis of gastroenteritis and died three days later from septic shock. Each of us knows many similar stories.

So, it is difficult to make a diagnosis, because all patients are different (and medicine is a very complex science), the healthcare system is imperfect, and doctors are also people. What to do?

According to Mr. Graber, we should start by developing criteria by which we can assess the ability of a doctor (preferably a future doctor, but this is practically impossible) to clinical thinking in general and in certain situations in particular (for example, when providing emergency care). He emphasizes that in order to improve something, you must first learn how to measure it.

For example, Hardeep Singh from the US Department of Veterans Affairs Medical Center proposed a system of "triggers" (trigger tools) that indicate the degree of competence of a doctor. An example of such a trigger is the sudden hospitalization of a patient within two weeks after the initial visit to the doctor: if the specialist did not foresee a deterioration in health, he made a mistake with the diagnosis.

You can find ways to encourage doctors to admit mistakes and report them to some statistical center. For example, Robert Trowbridge from the Manx Medical Center (USA) suggested placing a special icon on the computer desktop – easily and anonymously.

But the most important thing is to create a space for discussing the problem of misdiagnosis, so that medical education and healthcare systems are improved, so that managers know why doctors make mistakes.

In conclusion, Mr. Graber implores the patients: stop being silent! Tell the doctor as much as possible, do not wait for leading questions, help him, and he will help you. And it would be just great if there were such units in the structure of the healthcare system where a patient could come and say: "Doctor so-and-so refused to listen to me, and it seems to me that because of this he could give me an incorrect diagnosis."

Keep an eye on what is written in the medical history and at the slightest suspicion of lying, sound the alarm.

Feel free to ask the doctor to decipher his scribble!

And please, dear patients, become conscientious historians of your health: remember conversations with doctors, follow their questions and reflections in order to understand the meaning of certain of your symptoms and inform specialists in time about the corresponding changes in well-being. Learn to understand the doctor – your life may depend on it.

Prepared based on the materials of The Conversation: The hidden problem of medical misdiagnosis – and how to fix it.

Portal "Eternal youth" http://vechnayamolodost.ru30.05.2013