The health care debate is a good time for us to consider cases of misdiagnosis.
Picture this: You’ve noticed a suspicious lump in your breast. You drop by the doctor’s to have it examined and you’re told it’s a cyst of fatty deposit. Nothing to worry about. So you don’t worry, and the next time you see a doctor it’s because you’re pregnant.
But now he orders a mammogram. And it proves what you feared all along: The lump is cancer, it’s metastasizing, spreading to other parts of your body, and a doctor’s gut feeling cost you your best chance at an early recovery.
This was the situation that recently led Courtney Hill into a clinical misdiagnosis lawsuit, according to the Rasansky Law Firm. She won, but much of her settlement will subsidize her medical bills, and both the doctors and Mrs. Hill would probably prefer that she was diagnosed properly in the first place. Mrs. Hill’s predicament is not an isolated event, and the odds are that you yourself will be in her shoes at some point in your life.
Dr. Lisa Sanders, a lead technical adviser behind the popular diagnostics show “House,” scrutinizes our health care system’s bad diagnostic habits in her new book, “Every Patient Tells a Story.”
Sanders says that the heart of the problem is in doctor-patient interaction, in the first visit to the examination room. Patients rattle off their symptoms and 20 seconds later the doctor interrupts with a question ““ a leading question. They’ve already formulated a hypothesis about the patient’s condition. From here on in, the doctor will be attempting to confirm their diagnosis, not postulate alternatives. And the patient will give them only the information they ask for, which may not be the information they need.
But forget bad diagnostic habits; the trouble modern American medicine is faced with, Dr. Sanders says, is not diagnostic habits. For 20 years, medical journals have been graced with titles like “The Demise of the Physical Exam” and “Must doctors still examine patients?”
Must pilots fly airplanes? If not through the physical exam, how are we being diagnosed?
The answer is in the exam room, right after the leading questions are done. This is when the doctor orders an MRI, CT or other high-tech lab test. The patient mistakes the test for treatment, a fallacy doctors encourage because it shuts the patient up and gets them out of the exam room. Then the doctor is free to call in the next patient, which is how private medical groups profit ““ not by diagnosing you, but by letting the maximum number of patients see their doctor.
Lab tests should be diagnostic supplements, not diagnosticians, but they’re replacing doctors for good reason. Test results are quantifiable justification for a course of treatment, erroneous or not, and that’s how they’re used in malpractice lawsuits. By ordering tests, doctors are not only clearing patients out of the exam room, they’re protecting themselves from being sued.
Here’s the vicious cycle: Doctors develop a fear of malpractice. They then take steps to avoid lawsuits, which means relying on tests. Tests replace the physical exam. Doctors begin to regard the physical exam as useless. Patients are misdiagnosed, malpractice suits ensue and doctors have an even greater incentive to rely on tests.
Besides disallowing tests as evidence in malpractice suits, the only way out of this loop is open, exploratory dialogue during physical exams. But the elephant in the exam room is that patients don’t actually want to pour their hearts out to their doctors. They would rather trust in the cold, hard science of a laboratory test, but what they forget is that there are human beings interpreting their test results, and they were sent to the lab in the first place by a living, fallible person.
Holding still in an MRI machine is uncomfortable; so is losing an arm to unnecessary surgery. But it seems patients would rather suffer this than risk real, personal interaction with their doctors, and doctors are more than happy to oblige their shyness.
The misdiagnosis problem isn’t insurmountable. As a patient, you can ask the hard questions and make sure those claiming to treat you know you, not the sum of your symptoms. And to UCLA’s pre-med students, consider reading Dr. Sanders’ book. It’s fun and might even help you become the kind of doctor patients love.
If you have a misdiagnosis story to share, e-mail Dosaj at tdosaj@media.ucla.edu. Send general comments to viewpoint@media.ucla.edu.