Misdiagnosis teaching and assessment tool

Peggy Zuckerman peggyzuckerman at GMAIL.COM
Sun Jul 28 20:09:40 UTC 2013

I was misdiagnosed as having a "tiny, scabbed-over ulcer" to account for a
6.6 hemoglobin reading, which never approached a normal range until my 9x10
cm kidney cancer was removed...,

I always wonder how both my doctor and I might have responded in the early
months if I had known (or my doctor had known) how very rare it is to find
a well-fed suburban woman who likes to eat having such a low hemoglobin.
Additionally, how common is it to find an ulcer that is not accompanied by
h. pylori, and how many scabbed over ulcers do not show up on a pathology

The reality is that the first impression/first diagnosis is very difficult
to dismiss, as studies have shown.  The bias to keep that first impression
and work accordingly is very common.  Most importantly, most patients could
quickly understand that bias, as they all have likely had a "wrong" first
impression, and understand how difficult it is to correct that.  Imagine
the patient learning to ask, "That first impression was x, but now that you
have this extra time, lab data, lack of response, etc, what if you put that
aside, and took a fresh approach?"  "WHAT ELSE COULD IT BE?" should be part
of the discussion, when something is not resolved as anticipated.

This is a simple lesson, both for doctors and patients, and one that I
teach my friends and family.

Peggy Z
Nine years later, still ticking.

On Sun, Jul 28, 2013 at 9:05 AM, Bob Swerlick <rswerli at gmail.com> wrote:

> Yes, it is all about providing feedback in a time frame that is relevant.
> The challenge in medicine is that this does not happen in any meaningful
> way in the outpatient setting.
> ------------------------------
> Peggy Zuckerman

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