“Doctors bury their mistakes” is a sad, but unfortunately not completely untrue saying.
A study published in the British Medical Journal Quality and Safety in 2013 estimates that 10 to 15% of diagnoses made by doctors are completely wrong. (The study also found major diagnostic discrepancies in 10-20% of autopsy cases.).
In fact, medical care is the third leading cause of death in the United States. I'm sure in South Africa things may not be much different, even if they are for different reasons.
As a GP in my 'previous life', I encountered rather strange diagnoses made by my colleagues in clinical practice.
When diagnostic errors surface, to me, the most important thing is to determine if negligence was involved or not. When a wrong diagnosis involves negligence, it is a whole different issue than simply a mistake. It becomes a matter that cannot be excused. The doctor is to blame. End of story.
Negligence vs. mistake without negligence
I once saw a young boy who injured his arm after he had fallen from a tree. He only came to see me a couple of weeks after the accident.
The doctor who initially saw the boy decided that, because of minimal swelling, it was unlikely that a fracture could be the cause of his significant pain. His clinical notes stated “soft tissue injury” as the diagnosis.
I quizzed the mother, who said the doctor did not ask when the injury occurred (it happened more than a week before the first consultation, and they struggled to get him to hospital from a farm).
The doctors placed the boy’s arm in a sling and sent him home.
On closer examination, the boy’s forearm had limited swelling (which is to be expected as it was almost two weeks after the injury), but after examining his arm more closely, I felt a clear, displaced fracture. X-rays confirmed the broken bone. This, to me, is an example of negligence!
Can it be considered negligence if a doctor makes a mistake when a patient withholds information?
A friend of mine once consulted a patient who came to the emergency room with what appeared to be a lung infection. The patient did not tell the doctor that she is allergic to penicillin, even though she asked her (it was noted in her clinical notes).
The patient then suffered a severe allergic reaction when she was prescribed penicillin-containing medication and attempted to blame to the doctor.
The difference between negligence and an honest mistake is a fine, but clear line. Proving negligence is, however, not always easy.
Why do doctors misdiagnose?
A medical consultation is not only an examination with a script at the end. It is a two-way engagement where the doctor is guided by a physical examination and the information he or she gleans from a patient before a treatment plan is formulated.
If there is poor communication from the doctor or patient’s side, problems arise.
A university professor of mine once said that 80% of your diagnosis can be made by just listening to your patient. The physical examination then narrows down your list of probable causes. By not listening or nor examining the patient properly, doctors can make errors.
I know of doctors who never leave their desks to examine patients. They make a diagnosis based on history alone.
They order a myriad of special investigations – almost every possible blood test as a shot in the dark to hopefully hit a diagnosis. This is not good clinical practice, and the wrong diagnosis often results in more tests, more errors and exorbitant medical bills.
By not listening to a patient, a doctor might be directly responsible for a patient’s death.
I remember another case. A patient had died at home and was brought to hospital by the undertakers to be certified dead. According to the undertaker the patient probably died from a lung infection because that is what the doctor in question had diagnosed earlier that day when the family took her to hospital because of severe shortness of breath.
When another colleague examined the body, she was immediately concerned that the cause of death might not be a lung infection but heart failure, as the patient was severely oedematous.
When reviewing the patient’s file she noticed that she’d had cardiac failure. The doctor who diagnosed her only wrote “pneumonia” on her file and gave her a course of antibiotics. There is no proof that he ruled out decompensated heart failure as the possible cause of her severe shortness of breath.
When should you change your doctor?
I often say that if patients knew exactly what was wrong with them and how to treat themselves, they would not go to their GP. But patients are not medically trained and therefore rely on a doctor to treat them. However, not all doctors are good doctors.
When should you change your doctor? If any of the following points describe your doctor, you should perhaps reconsider your options:
1. A doctor who never listens and never examines, or only listens, or only examines.
2. A doctor who does not explain your condition or treatment plan is probably not
a good choice. Part of treating a patient is education. If you don’t know what is
wrong with you, or how you are being treated, best would be to find a doctor who will
explain the situation to you.
3. A doctor who orders every single test on the laboratory or radiology request form. Special investigations are used to rule out or support a possible diagnosis. Ordering too much bloodwork and imaging, is not good practice.
4. Paternalistic doctors (who treat you like a child and don’t include you in the decision making) are not good choices. Treating a patient successfully can only happen when both the patient and doctor agree on a treatment plan.
What's your experience?
Have you been misdiagnosed or ill-treated or brushed off by your GP? What is his/her bed-side manner like? Do you think you deserve better? Let us know in the comments or send an email about hour experience to firstname.lastname@example.org
Why would anyone want to become a doctor in SA? (M&G Thought Leader)