Premature psych conclusions, and harm from misdiagnosis

Lorri Zipperer Lorri at ZPM1.COM
Fri Jul 26 18:25:46 UTC 2013

Forwarded by moderator: 


>>Interesting. This psych issue is dangerous as, by definition, if somebody
has a mental problem the temptation is to treat whatever they tell you
(symptoms) with a pinch of salt. A powerful bias has been created before you
have even started. As true in life in general as in medicine.



Jason Maude

Founder and CEO Isabel Healthcare
Tel: +44 1428 644886
Tel: +1 703 879 1890 <> 


From: xavier prida <xprida at BAYHEARTGROUP.COM>
Reply-To: Society to Improve Diagnosis in Medicine
Date: Friday, 26 July 2013 13:13
Subject: Re: [IMPROVEDX] ***SPAM*** Re: [IMPROVEDX] Crowd Wisdom, Premature
psych conclusions, and harm from misdiagnosis


Whether it be cognitive or visual learning or both(clinicians often need
integrate both) I happened upon this piece in of all sources, Sports
Illustrated, elucidating the concept of "chunking". Performance(athletic or
otherwise) is dependent on a trained mind and imagery with contextual
organization. [broken link removed].


From: Deborah Akinniyi [mailto:deborah.akinniyi at YALE.EDU]
Sent: Thursday, July 25, 2013 2:11 PM
Subject: Re: [IMPROVEDX] Crowd Wisdom, Premature psych conclusions, and harm
from misdiagnosis

Hello everyone,

My name is Deborah Akinniyi, and I'm an internal medicine resident who
became interested in diagnostic error during my third year of medical school
after my first patient died... When he died, I wept... and I was angry. My
team said there was nothing we could do, that these things happen, and that
with patients like him the outcome wasn't surprising. I didn't accept these
notions, because deep inside, a gnawing feeling told me we were wrong;
despite the type of patient he was, or the psychiatric and medical
comorbidities he had, his death could have been prevented.

These feelings pulled and pushed me towards careful review of his case,
acceptance that even the most seasoned doctors make mistakes, and my
introduction to diagnostic error. I confirmed that we were wrong, and found
that my patient's story was an unfortunate case of delayed diagnosis,
cognitive biases, and diagnostic error proved deadly. Since then, I've
remained interested in reducing diagnostic error through various means,
including sharing my experiences with other physicians so that we can all
learn from it.
I have a case of a patient who was being "dismissed as psych" so strongly
that her inspiratory chest pain, palpitations, and sinus tachycardia were
dismissed as consequences of her pre-existing psychiatric disorders. Prior
to coming on service, I was told that she was completely fine, had no
current medical issues, and was just waiting for an inpatient psych bed. I
was told, "Don't be alarmed if she complains of chest pain... It's just the
way her anxiety presents." I was even given specific instructions not to
pursue a pulmonary embolism (PE) work-up... "She does not have a PE."

It turns out, this patient had multiple PE's. She also had a personal
history of spontaneous abortions, and a family history of blood clots.
Later, we confirmed that in addition to her pre-existing psychiatric
disorders, she has a genetic clotting disorder.

When I reflect on this case, I'm forced to realize that had I not been aware
of how common various biases can lead to delayed diagnosis and diagnostic
error, this woman may have continued to go untreated, worsening her physical
health, and her concerns may have continued to be minimized and dismissed,
worsening her mental health. I also suspect that patients with pre-existing
psychiatric disorders likely suffer from delayed and misdiagnosis more
commonly, and agree that the implications this has on the financial burden,
patient safety, mental health, physical health, and the overall
doctor-patient relationship in this group are frightening.

I plan to fully analyze this case from a diagnostic error standpoint and to
review the literature on the specific biases that affect the care of
patients with pre-existing psychiatric disorders. I plan to eventually write
a case report on this, and am sure that through that process, I'll learn
even more about diagnostic error and how to prevent it. If any of you have
experiences, articles, or papers you'd like to share, please send them my
way! Also, if you have any questions for me, or any advice to help me as I
continue through residency and develop as a physician, I'm all ears and open
for mentorship. I'm inspired by you all, and I look forward to continuing
these conversations.


Deborah Akinniyi

Deborah C. Akinniyi, MD, MS

Yale Internal Medicine Residency Program

MD, George Washington University, '12

MS/BS, Stanford University, '08

Email: deborah.akinniyi at, chinenye at

Forwarded by: 


Lorri Zipperer, Cybrarian

List Moderator

Communications Co-Chair

Society to Improve Diagnosis in Medicine

twitter: @ImproveDX

lorri at

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