The patient experience of diagnostic error

Abdul Saadi essadii at GMAIL.COM
Sun Oct 20 20:40:01 UTC 2013


I can very easily imagine pernicious anemia getting missed and slipping through the cracks. 
Pernicious anemia is what you can call an orphan disease one that is systemic present most of the time atypically not immediately fatal and spans multiple specialties.

Vague abdominal pain .. neuropathy maybe. So patients may present to all different specialist who will do thier usuall rule outs. Since it is not immediately fatal, it will get delegatd from one provider to the other. Another important aspect is when one anemia coexist with another. Whole mark of pernicious anemia is a high MCV, add in iron deficiency to the mix and most astitue clinician would easily brush it off .. you know ! rule it out. And that is a big issue I  my opinion in terms of mental and diagnostic erros. As physicians we tend to compartmentalize diseases thinking that the chances that two processes coexisting are very distant. It is the way doctors are thaught. 

Most of Phyicians lump up things in what I call the ten conglomerates of diseases .. you know them CHF , COPD , PE and so on. Anything outside of these "common syndromes" aka bread and butter of medicine, would be considerd an atypical presentation of these diseases. 

It is not uncommon that we hear the phrase ..oh we ruled out ACS and we ruled out PE that is supposed to make me feel happy as an attending but it does signal lack of direction.

Finally, big institutes, mine included could easily fail in delineating a tricky diagonosis. First they fall victim to the same mental traps and heurestics that everybody else is exposed to. Second, not unusually a patient is transfered from the so  called "OSH" , outside hospital. Those cases are usually sent ahead with the same wrong impression and some sort of requirment of an advanced procedure. Sometimes they get  to the wrong floor or the wrong super subspecialist unless a really good resident or fellow picks up a different scent. 




Sent from Samsung tablet

-------- Original message --------
From Janel Hopper <janelhopper at COMCAST.NET> 
Date: 10/20/2013  12:42 PM  (GMT-05:00) 
To IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG 
Subject Re: [IMPROVEDX] The patient experience of diagnostic error 
 
My pernicious anemia was misdiagnosed at major institutions for decades.
Experts seem unsure whether it is a rare condition or not. They remember seeing it on their Board examination.

Sent from my iPhone

On Oct 20, 2013, at 8:03 AM, Edita Falco <edita.falco at GMAIL.COM> wrote:

Am afraid that not only rare diseases are  misdiagnosed..much common conditions are usually misdiagnosed or  delayed 
appendicitis, intususseption, hearth attack meningitis..and a long list!


On Sat, Oct 19, 2013 at 10:55 PM, Graber, Mark <Mark.Graber at va.gov> wrote:
Hi Tim - you've asked an interesting question and I'd be interested to know the answer too.  I'm not aware of any studies that have studied the patient's reactions to diagnostic error.  Lets see what others say, but the door may be open for you to be the first to study this.

Our Society has been discussing the possibility of sponsoring a web site for patients to tell their diagnostic error stories.  This would be an ideal place to identify patients who might be willing to participate in such a study.  In the meantime, I'm sure the people on this listserv could help you identify a good number of such patients if you wanted us to do that.  I'm just not sure the patients we know would be a representative sample though, as you might imagine.

   Mark

Mark L Graber, MD FACP
Senior Fellow, RTI International
Professor Emeritus, SUNY Stony Brook School of Medicine
Founder and President, Society to Improve Diagnosis in Medicine
Phone:   919 990-8497
[cid:3465060902_18428732]


________________________________
From: "Siggs, Tim" <ts228 at LEICESTER.AC.UK>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, "Siggs, Tim" <ts228 at LEICESTER.AC.UK>
Date: Sat, 19 Oct 2013 08:01:35 -0400
To: <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [IMPROVEDX] The patient experience of diagnostic error

Good afternoon all,

I am a Clinical Psychology trainee at the University of Leicester, UK, with an interest in Diagnostic Error and am conducting research into this area for my doctoral thesis. As a clinical psychologist to be,I am particularly interested in the patient experience of diagnostic error with a view to understand the implications of either experiencing, or perceiving the experience of, a diagnostic error with reference to future health behaviours in patients with chronic illnesses e.g. self management of a chronic condition, adjustment, treatment adherence etc. I have followed this listserv for a number of months and have found it to be an interesting and insightful source of topical information, thank you all.

I am writing today to ask for thoughts and suggestions regarding my research both generally and for a specific question. Firstly there appears to be a lack of published studies exploring the depth of experiencing diagnostic error from a patient perspective, there are several studies looking at adverse events as a whole which include diagnostic error within them (e.g. Elder et al., 2005; Entwistle et al., 2010; Kistler et al., 2010; Kuzel et al., 2004; Mazor et al., 2012; Molassiotis et al., 2009; Ocloo, 2010), but do not offer specification of the diagnostic error experience in itself, and I believe that the impact may be very different for diagnostic error. I feel that illuminating this perspective may help to address the psychological and emotional impact of diagnostic error such as that which can present in a medical psychology department, and this knowledge may also inform ideas regarding the process of diagnostic error from the patient's perspective. So my question to ask is does anyone know of any studies, particularly qualitative, that examine the patient experience of diagnostic error or have any particular thoughts on this topic area? In particular I'm interested to know if there are any identified (evidence based?) approaches to supporting patients who have experienced diagnostic error anyone is aware of?

Having searched much of the literature I am cognizant of the moves to bring the patient into the patient safety process and also diagnostic error and hope that my proposed research can add to this. Any thoughts or ideas you may have are welcomed.

Many Thanks

Tim

Tim Siggs
Trainee Clinical Psychologist
University of Leicester
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