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

Amy Reinert amy.reinert at GMAIL.COM
Fri Jan 17 15:08:06 UTC 2014

Someone earlier in this thread mentioned the difference between "special
cases" and discussion of general principles.

Rob's point here about communication, combined with the personal
anecdote, brings an important aspect of research, as well as problem
solving, into focus. Misdiagnosis, on most fronts, appears to originate in
the domain of human experience. There is a lot of great science and
techonology that supports the ability to make accurate diagnoses, but as
we've noted in so many different words, at the end of the day, the practice
of medicine is a human endeavor. When researchers must reach for anecdotal
reports to support theories or arguments, it is an indicator that there is
a significant gap in the research. There has been a great deal of
discussion on another thread about logic and decision making processes. All
well and good, and important, I think, to improving diagnosis. However, in
reading these postings and reviewing the literature, it has become apparent
to me that there is a need for qualitative research regarding
misdiagnosis-- both from the patient and physician perspectives. I believe
that thoughtful collection of anecdotal reports, combined with meta
analysis of the existing literature, will guide the way to significant
advances in improved diagnostic accuracy.

Amy Ruzicka, Ph.D.

On Thursday, January 16, 2014, Robert Bell <rmsbell200 at> wrote:

> Mis-diagnosis and delayed diagnoses are common, but so is delayed
> communication of diagnosis, particularly in stressful situations.
> A relative waited 3 weeks after a mammogram to be told that a breast
> biopsy was negative for cancer.
> Rob Bell
> Sent from my iPad
> On Jan 8, 2014, at 5:49 AM, Vic Nicholls <nichollsvi2 at GMAIL.COM> wrote:
> > 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
> problem.
> >
> > 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.
> >
> >
> > Victoria
> >
> > 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:

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