Why Are So Many Women Being Misdiagnosed? | Glamour

Peggy Zuckerman peggyzuckerman at GMAIL.COM
Sat Aug 12 15:17:36 UTC 2017

This exactly the kind of articles which will have impact on the public--and
patients in general--about the way to prevent errors in diagnosis.  Many
people who have had problems getting diagnosed assume that they were either
'unlucky' and that this type of error is uncommon.

Wish they had made the Patient ToolKit, which was developed by SIDM's
Patient Engagement Committee, available in the article.  I attach here for
use by anyone.  And encourage any additional corrections, additions, etc to
be sent to me.

Peggy Zuckerman
Patient Engagement Committee

Peggy Zuckerman

On Fri, Aug 11, 2017 at 8:54 PM, HM Epstein <hmepstein at gmail.com> wrote:

> I'm happy to see the major consumer press printing such thorough articles
> on diagnostic error. This one quotes Dr. Hardeep Singh among others and is
> in Glamour Magazine.
> Best,
> Helene
> https://www.glamour.com/story/why-are-so-many-women-being-misdiagnosed
> Why Are So Many Women Being Misdiagnosed?
> August 11, 2017 10:44 am
> PHOTO: Edie Nadelhaft/Christopher Dawson
> Emily was bedridden with severe cramps, but five doctors told her she was
> simply “unlucky” to have painful periods. Tina had crushing chest pain yet
> was sent home from the hospital and told she had a gastrointestinal
> problem. Tanieka’s doctor attributed her fatigue and heart palpitations to
> stress. Jennifer’s M.D. diagnosed her terrible abdominal pain as a side
> effect of depression.
> All these women have one thing in common: Their doctors were wrong.
> About one in 20 American adults are misdiagnosed at clinics and doctors’
> offices each year, and almost everyone will experience at least one
> diagnostic error in her lifetime. Some of these errors are
> unavoidable—doctors are only human. But what’s shocking is that physicians
> aren’t getting better at avoiding these mistakes. Back in 1999, one report
> showed that up to 98,000 deaths a year were caused by medical error in
> hospitals. Today, more than 15 years later, Johns Hopkins University
> estimates the number is more than 250,000. That makes medical error the
> third leading cause of death in the United States, behind heart disease and
> cancer. And for women in particular, the numbers are especially alarming: A
> 2016 study found that women have a 50 percent higher chance of receiving an
> incorrect initial diagnosis after a heart attack; strokes, too, are 30
> percent more likely to be overlooked in women. Autoimmune diseases, which
> are three times more common in women, take roughly five years to be
> correctly diagnosed, and female-specific conditions like endometriosis
> often take a decade of doctor visits before they’re accurately identified.
> Women, in other words, are more likely to be misdiagnosed in pretty much
> any medical situation.
> What gives? There are a few key factors working against us: the way we
> behave in the doctor’s office, the way doctors respond to that behavior,
> and what doctors are taught about gender and medicine. More specifically…
> *Problem #1: Doctors Think We’re Too “Emotional”*
> This might sound like a relic from a bygone era when doctors regularly
> diagnosed women with hysteria, but no—the idea that women are too
> “emotional” persists in 2017, and it’s a menace to our health. Sometimes
> physicians make this assumption just because of the way we talk. “The
> ‘feminine’ way of describing what’s wrong is to build a story,” explains
> Marjorie Jenkins, M.D., chief scientist at the Laura W. Bush Institute for
> Women’s Health at Texas Tech University. “I might tell the doc my neck
> hurts and I’m having bad headaches, which is stressful because I have to
> clean up my house before my in-laws arrive and my husband is no help.” And
> doctors are time-pressed: “Visits today are rushed—the average appointment
> is only 15 minutes,” says Hardeep Singh, M.D., M.P.H., patient safety
> researcher at the Houston VA Medical Center. If you cram that time with
> every detail of your story, the doctor may forget your most critical
> symptoms.
> Jennifer, 43, saw this firsthand when she was seeking help for stomach
> pains so debilitating she couldn’t leave her house. “I told my GP about my
> symptoms, but I also said I had two small children and a husband who
> traveled for work,” says Jennifer. “The doctor never even examined me; he
> just said I was depressed and overwhelmed because of that and recommended I
> look into antidepressants. I left feeling angry and ashamed.” So she
> reached out to another doctor, who ordered a CT scan, and the results
> revealed she had a grapefruit-sized tumor in her appendix. “It was pressing
> on my colon, causing it to spasm,” says Jennifer. “If I’d waited much
> longer, they said, I might’ve died.”
> In other instances our physical symptoms can get very tangled with
> psychological ones. For example, the heart attack symptoms women are more
> likely than men to experience—difficulty breathing, rapid heart rate, and
> sweating—are also hallmark symptoms of anxiety. Women too may be more apt
> to cry and share how they feel as they describe their symptoms, increasing
> the risk of being given a psychiatric diagnosis when the problem is
> actually a physical one. “Doctors used to tell women they were being
> hysterical; now the code word is stress,” says Julie Holland, M.D., a
> psychiatrist in New York City. “But by telling a woman she’s just stressed,
> it negates her entire experience, and unfortunately, this also means
> doctors don’t get to the root cause.” Not to mention that you can be
> stressed about potentially being sick while also, you know, being sick.
> Tanieka, 34, was told it was “stress” that was causing her laundry list of
> unexplained symptoms, including dizziness, fatigue, and the feeling that
> her heart was going to bounce out of her chest. “The doctor said it was the
> pressure of nursing school,” says Tanieka. “When I asked if she was going
> to run any tests, she said, ‘No, you’ll be fine,’ but I knew something
> wasn’t right.” A week later, as she continued to have trouble breathing and
> her hands grew so swollen she couldn’t bend her wrists, she sought a second
> opinion. “An hour after my lab work, the doctor called and told me to go to
> the emergency room for a blood transfusion because I was severely anemic,”
> recalls Tanieka. “A biopsy revealed I had acute myeloid leukemia and needed
> to start chemo immediately. I was in complete shock.”
> *Problem #2: Women Are “Medical Mysteries”*
> In fairness to doctors, there is another reason women are so difficult to
> diagnose: The ailments that hit women hardest are some of the least
> understood. “Diseases like endometriosis are challenging to get right
> because they often mimic other things,” says Alyson McGregor, M.D.,
> cofounder of the Sex and Gender in Emergency Medicine Division at Brown
> University. “How the menstrual cycle affects a woman’s body is still kind
> of a black box.” Emily, 25, saw five gynos over eight years before
> discovering she had endometriosis. “They kept giving me different hormonal
> contraceptives; one doc prescribed a muscle relaxer,” she says. “No one
> ever mentioned endo. I was told I had crappy periods and had to live with
> it.”
> And it’s not just reproductive-system-related issues that baffle doctors;
> there’s still outdated research and training on universal health issues,
> like heart disease. Tina, 53, went to the E.R. after feeling terrible pain
> in the center of her chest but was told it was probably a GI issue and sent
> home. Nine days later her body felt like it was shutting down. “I threw up
> until I couldn’t throw up anymore and was so weak I could hardly walk, so
> we went back to the E.R.,” Tina says. She was given pain and antinausea
> meds and again sent home. In the morning, though, she went to a bigger
> hospital, where testing showed she’d suffered a major heart attack with 100
> percent blockage in a main artery. “The doctor said that my heart was
> barely beating,” says Tina. “I know heart issues are harder to diagnose in
> women, but they didn’t follow protocol. They should have kept me overnight.
> To snap doctors out of these habits, some physicians believe changing
> med-school curricula is key. “When a patient doesn’t fit the pattern
> doctors were taught in medical school, they’re less likely to recognize it
> and women are less likely to get the lifesaving treatment they need,” says
> Dr. McGregor. In fact, one study found less than half of medical students
> felt their curriculum prepared them to manage gender differences in a
> clinical setting. “We still aren’t teaching the basics,” says Dr. Jenkins.
> For example, her research found that only about 13 percent of med students
> reported being taught that men and women should get different dosages of
> certain insomnia meds. “Doctors tend to treat men and women similarly
> unless it has to do with reproductive parts,” she says. “That doesn’t
> work.” Some strategies to help you get the right diagnosis:
> *Strategy #1: Do Some Google Sleuthing*
> Despite what you may have read (even in this magazine!), Internet
> searching can be helpful. “Stick to trusted sites like the National
> Institutes of Health and those that are scientifically reviewed, like Mayo
> Clinic and WebMD,” says Dr. Jenkins. These sites are not a substitute for
> seeing a doctor IRL, to be sure, but if you bring good research to your
> appointment, it can help you explain what you’re experiencing in specific
> terms, which is crucial in those often-too-short visits. “What really helps
> is if you say, ‘I looked this up because I’m worried about a blood clot in
> my lung,’ ” says Dr. McGregor. “The more you can articulate your symptoms,
> the more efficient your doctor can be, and your doctor will be better able
> to provide guidance about your concerns.”
> *Strategy #2: Stick With the Facts*
> “If a man is upset, he’s taken more seriously, but when a woman gets
> emotional, doctors turn off,” says Dr. Holland. “So the more you can check
> your emotions at the door, the better.” It’s enraging, and you are not
> doing anything wrong by feeling emotional—this is doctors’ problem, not
> yours. But to improve communication, Dr. Jenkins suggests making a list of
> your symptoms, including when and how often they occur, so your issues look
> like a data set instead of a string of complaints. Say the symptoms
> clearly, and as soon as you see the physician. Don’t worry about the
> “story.”
> *Strategy #3: Consider a Female Doctor*
> New research has found that people cared for by female physicians live
> longer
> <https://www.glamour.com/story/study-finds-patients-with-female-doctors-live-longer>
> and are less likely to have repeat hospital visits than those cared for by
> male M.D.s. “The evidence suggests women follow guidelines more closely and
> may be more effective at communication with their patients,” says study
> author Ashish Jha, M.D., M.P.H., a professor of health policy at the
> Harvard T.H. Chan School of Public Health. Previous data has found women
> physicians invest more time and engage in more patient-centered
> communication than male colleagues, improving diagnostic accuracy. Of
> course, not every male doctor has these shortcomings! But if you’re
> choosing a new doc, you may be better off with a woman.
> *Strategy #4: Be Confident*
> “Women may be less likely to question their doctors because we’re more
> likely to defer to authority,” says Dr. Holland. Indeed, research shows
> young women sometimes delay seeking treatment for heart attack symptoms out
> of fear they will be judged for overreacting. “The best way to reduce
> medical mistakes is to ask your doctor questions,” says Dr. Jha. That goes
> for any ailment. Try: Why am I getting a specific treatment? Why aren’t I
> getting a certain treatment? Does this condition affect men and women
> differently? “Use your voice and don’t settle until you feel heard,” says
> Dr. Jenkins. “You have to be your own best advocate.”
> Sent from my iPhone
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> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

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