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

Vic Nicholls nichollsvi2 at GMAIL.COM
Wed Jan 8 12:49:57 UTC 2014

I can identify with this. I had a doctor who had seen cachexia and the
like, also figured out the first time from "normal" blood work (normal
for ranges but not for me) that I had a nutritional anemia. The "normal"
blood work had items showing high normal/low normal values in the
appropriate places. Allowing a computer or a person to simply read those
and not be able to interpret symptoms and then the blood work in light
of that, was what caused months of delay in getting treated.

I was able to figure it out by "google". I could figure it out by
searching medical resources (UpToDate, ClinicalKey, Medline/Pubmed)
because the criteria were never used by doctors. In other words, 10
doctors from various groups never used the correct criteria for diagnosis.

When the rates of misdiagnosis and delayed diagnosis are from 20 to even
40%, we've gone past "anecdotal". The biggest item doctors are sued for
are this. The lack of relying on the medical literature to diagnose is a

I can show that this issue is ignored. I've got enough links about
doctors and hospitals hiding their heads in the sand on it. Just a few
below. We're here to get a dialogue to see how to fix it without lawyers
and people getting hurt.

On top of that, claiming psych issues doesn't work. I got called bipolar
with no evidence of mania or depression. I got labelled as anorexia
nervosa without any evidence of excessive exercise or the diet that
would be normal for an anorexic.

pg 202-203, Medical Blunders by Robert Youngson and Ian Schott
Psychiatric misdiagnosis is common. An American doctor, Robert S.
Hoffman, blames the process on a chain of irreversible and tragic
events, whereby 'a primary physician applies a preliminary diagnosis of
mental disorder which is decisive in determining the patients'
subsequent course. Once the stigma of psychiatric disorder is appplied
to an individual it can be impossible to remove it. Of 215 psychiatric
patients in America, tests revealed that 41 percent should probably have
not been referred in the first place, 63 percent had wholly treatable
conditions. At a Manhattan psychiatric center, 131 patients selected at
random were examined, and it was concluded that up to 75 per cent of
them had been misdiagnosed when first admitted to the hospital. A
principal error is to mistake signs of physical illness as emergent
psychiatric problems. Instead of looking to practical remedies, which
may be connected to lifestyle, emotional problems or some biochemical
imbalance, the doctor prefers to lump what he does not understand under
the heading of mental illness and thrust a patient into an institution,
or put him on mind-altering drugs which may have irreversible effects.
Dr Vikas Saini, a cardiologist and president of the Lown Institute, a
healthcare think tank in Boston, is quoted by Reuters:
“Most of what we do in medicine doesn’t have empirical evidence” for
whether it works and for whom, said Saini. “Instead, it’s driven by
anecdotal evidence and professional opinion,” which doctors who practice
in the same area are likely to hear about and be influenced by,
especially early in their careers.


On 1/7/2014 10:49 PM, Alan Morris wrote:
> Thank you.
> "A retrospective Isobel analysis detected my problem by my 20s."
> This seems to be an anecdotal example of the value of decision-support
> tools - particularly when the clinical problem is unusual or has an
> unusual phenotypic expression.
> Have  a nice day.
> Alan H. Morris, M.D.
> Professor of Medicine
> Adjunct Prof. of Medical Informatics
> University of Utah
> Director of Research
> Director Urban Central Region Blood Gas and Pulmonary Laboratories
> Pulmonary/Critical Care Division
> Sorenson Heart & Lung Center - 6th Floor
> Intermountain Medical Center
> 5121 South Cottonwood Street
> Murray, Utah  84157-7000, USA
> Office Phone: 801-507-4603
> Mobile Phone: 801-718-1283
> Fax: 801-507-4699
> e-mail: alan.morris at
> e-mail: alanhmorris at
> On 1/6/14 7:32 PM, "Janel Hopper" <janelhopper at COMCAST.NET> wrote:
>> 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

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