Ideas on improving rates of missed/delayed diagnoses in PCP type visits.

Janel Hopper janelhopper at COMCAST.NET
Tue Jan 7 02:32:41 UTC 2014


Hi All,

Some might recall that after great delay, I was diagnosed with pernicious anemia. I think that a lot of what passes for diagnosis is BS. 5 hematologists at major institutions now confirm my pernicious anemia. But some clinicians can't get their head around it since I wasn't often overtly anemic. Members of a major clinic might have trouble admitting they were wrong. Easier to call the patient crazy and slap on DXes with no laboratory verification. Physicians SAY they are going to work with patients who do some of the diagnosis lifting somehow through the Internet. My experience is that this is the very rare physician.

They insist on b12 levels and are wholly uninformed about the inaccuracies of these tests.

Rather than hypothesize about misdiagnosis in the abstract, I challenge any of you to do a post mortem of my 35 year saga. I'm sure other members of the Pernicious Anemia Society would also offer up their records.

A retrospective Isobel analysis detected my problem by my 20s.

But the physicians were (and many still are) only willing to consider the case through their limited misunderstanding--such as that overt anemia must always be present with pernicious anemia. Why check the literature since when one is highly confident?

Please feel free to contact me if you are interested in my challenge or more details.

Janel

Sent from my iPhone

> On Jan 6, 2014, at 10:50 AM, Vic Nicholls <nichollsvi2 at GMAIL.COM> wrote:
> 
> Would a change in medical education to include more EBM, reference clinical tools such as Isobel or UpToDate/ClinicalKey/MDConsult, help with less missed/erroneous diagnoses? Would another method of
> gathering data from a patient help, in terms of more effective H&P? Would more emphasis on a physical exam vs. tests help?
> 
> How about a change in testing and what is tested? I know there have been articles out regarding radiology exams, that they appear to focus more on physics and other aspects not related to patient care type issues.
> 
> Would an emphasis on understanding lab work help? I know I've been able to figure things out by understanding what a test is and what it is looking for.
> 
> Have doctors ever considered whether patient education would help? If I have a few educated patients, would I be willing to allow them to be more participatory than others? What is the attitude towards medical research brought by a patient?
> 
> Victoria
> 
> 
> 
> 
> 
> 
> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for Improving Diagnosis in Medicine
> 
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