“My dad had the wrong diagnosis…that’s why he wasn’t getting better,” said Mary.
He kept complaining of pain in his upper back. His doctor kept ordering more pain medication and wanted to do surgery on his back.I was scared; he had lost a lot of weight and was getting weaker and weaker. Even though his doctor had a good reputation, even teaching at the medical school, I decided to get a second opinion.
Well, to make a long story short, my dad had a tumor in his lung. He’s getting the right treatment now, but it’s probably too late.
Experiences, like Mary’s dad had, happen more often than you might hope. About 15 percent of all patients receive the wrong diagnosis reports Arthur Einstein in Clinical Reasoning in Health Professions.
Missed diagnosis accounts for about 50,000 deaths in the United States and Canada each year reports Jerome Groopman, MD in How Doctors Think.
The diagnosis forms the final judgment on what’s wrong with you, what’s causing your symptoms…if the diagnosis is wrong the treatment will be wrong.
Here we’ll look at what you can do to avoid a wrong diagnosis. We’ll start with a look at how doctors make a diagnosis, then we’ll turn to how it can go wrong. We’ll conclude with some simple questions you can ask that help get the right diagnosis.
How do doctors make a diagnosis?
Doctors base their diagnosis on what you tell them about your symptoms and health history as well as their physical examination of your body and its functions. This information may prompt the need for more information, so tests may be done.
The information from all these sources, when combined, forms a pattern. The doctor compares this pattern with other patterns of known diseases or injury types…then comes up with the diagnosis.
What might cause a wrong diagnosis?
- The doctor doesn’t have important information. Making the right diagnosis requires a good partnership between you and the doctor. You need to report all your symptoms and important factors in your health history. Your doctor needs to respect you and listen to you.Yet, “Observers have noted, on average, that most physicians interrupt patients within eighteen seconds of when they start telling their story,” reports Groopman. This interruption may break your train of thought leading to loss of information important for the diagnosis.
- Your pattern of symptoms doesn’t fit with other patterns the doctor knows. People are similar, but they are also unique so injuries and disease may show up differently depending on the person.Another factor may be lack of knowledge about your condition or its treatment. Doctors don’t and can’t know everything, so it’s important that they recognize this and are open to other information or to referring you to another health care provider.
- The doctor makes mistakes in her or his thinking. Dr. Groopman groups these kinds of mistakes into three categories: anchoring, availability, and attribution.Anchoring describes the tendency to “grab on to” the first symptom, physical finding, or test finding, and prematurely stop looking at other sources of information.Availability refers to the tendency to assume that the more easily remembered (or most recent) experience can explain the new situation. This could be the most recent pharmaceutical sales person’s presentation on a new drug or the last patient seen with similar symptoms.Attribution is the “stereotyping” of a person and then attributing the characteristic of the stereotype to the person and their symptoms.
One example might be stereotyping a disheveled chronic pain patient as “drug seeker,” leading to discounting the patient’s information.
How do you uncover a wrong diagnosis?
Not only is it appropriate for patients and their families to ask questions; it’s essential to getting the right diagnosis. Asking questions gives you the information you need to make decisions that support natural health and healing.
Here are 4 good questions gleamed from Groopman’s and my own experience to get you started:
- “Doctor, are you listening to me?” It’s easy for doctors to get distracted, they could be thinking of a previous patient or a busy schedule. As long as you ask the question respectfully, it helps them refocus their attention on you.
- “What else could it be?” A favorite of Dr. Groopman, this question helps prevent the doctor from making the diagnosis too quickly and prompts thinking of other possibilities.
- “Could two things be going on to explain my symptoms?” It’s not unusual to have more than one thing contributing to symptoms.
- “Is there anything in my history, physical examination, or tests that don’t fit with this diagnosis?” This question helps counter the tendency to discount information that doesn’t fit into the physician’s original thoughts for diagnosis.
Good two-way communication is the key to avoiding a wrong diagnosis. A good question prompts another look at the information. Let the doctor know all your symptoms and health history. Share what your think might be causing your symptoms.
Still think you might have the wrong diagnosis…get a second opinion.
Most doctors try hard to do the right thing. They pride themselves in treating disease and injury, and easing pain for their patients. Yet, they’re human, too, subject to all the imperfections we all experience.
The last thing they want is to make the wrong diagnosis.
Don’t be shy about holding up your end of the partnership or seeing another doctor if he or she doesn’t seem to respect or listen to you. You are the expert about you!