Doctors Frequently Make the Wrong Diagnosis



A new study finds that internists make the correct diagnosis in only 55 percent of simple illnesses, and in just 6 percent of complex cases.


 

DOCTORS FREQUENTLY MAKE THE WRONG DIAGNOSIS

When we see our doctor because we are sick, most of us expect that we will leave his or her office with a reasonably accurate diagnosis, and the appropriate treatment recommendations for our illness.  However, a newly published clinical research study suggests that these expectations might be rather unrealistic, particularly if we are suffering from an illness that requires a reasonably complex evaluation by our physician.  This new clinical study appears in the current issue of JAMA Internal Medicine.

In this study, 118 general internists were recruited from throughout the United States.  All of these physicians were asked to provide a diagnosis for 4 previously validated patient scenarios, including both straightforward and complex clinical cases.  These doctors were asked to provide their diagnoses after reading the histories, physical examination findings, general diagnostic testing results, and disease-specific testing results for each of these 4 cases.

The results of this clinical study were not exactly reassuring to prospective patients….   The 118 participating internists came up with the correct diagnosis for only 55 percent of the straightforward cases.  When it came to making the correct diagnosis for the more challenging patient scenarios, the physician-volunteers in this study correctly diagnosed only 6 percent of the more complex clinical cases!  Moreover, the doctors who participated in this web-based clinical study appeared to have little insight into their diagnostic shortcomings, as their very high level of confidence in their diagnoses was similar for both the straightforward cases and the more complex cases.   This latter finding led the study’s authors to question whether or not physicians who are dealing with complex patient cases realize how likely their diagnosis is to be wrong.  (If a physician is unaware that his or her diagnosis is very likely to be wrong, then they may miss an opportunity to perform a more in-depth evaluation of their patient.)

While this is a small pilot study, its findings are nonetheless quite disturbing.  It suggests a simultaneous lack of diagnostic accuracy and over-confidence on the part of at least some physicians when it comes to evaluating patients, arriving at a correct diagnosis, and (hence) prescribing the correct treatment.  Whether or not the findings of this small study can be generalized to all internists (or to all doctors in the United States) is not clear.  However, the disconcerting findings of this clinical study should serve as a red flag to physician residency training programs and physician certification boards.  Meanwhile, becoming an educated healthcare consumer, and asking your physician to explain his or her assessment to you, may be just what the doctor ordered!

 

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.com Top 100 New Book Releases in Cancer” list.

 

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According to recent Bureau of Labor Statistics, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is more than 12 percent.  A new website, Veterans in Healthcare, seeks to connect veterans with potential employers.  If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I would also like to personally urge you to hire a veteran whenever possible.


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  Over the past 12 months, 3.5 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious readers.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 


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Surgeon Performance Impaired After Drinking Alcohol the Day Before Surgery

Welcome to Weekly Health Update


“A critical weekly review of important new research findings for health-conscious readers”



 

SURGEON PERFORMANCE IMPAIRED AFTER DRINKING ALCOHOL THE DAY BEFORE SURGERY

Surgeons, like pilots, are held to a very high standard of conduct when it comes to alcohol and drug use. Unlike pilots, however, there are no rules barring surgeons from having a few beers, or other alcoholic drinks, on the day or evening before they enter the operating room to perform surgery.

While most surgeons drink alcohol responsibly, some surgeons (like people in any other profession) may occasionally have a few more drinks the day or evening before they report for duty than might be considered prudent. When a surgeon has a few more alcoholic drinks than they might have planned on the day before they are scheduled to perform surgery, most will undoubtedly assume that “sleeping it off” overnight will leave them fresh and in tip-top shape to wield the scalpel in the operating room on the next morning. However, a newly published clinical research study suggests otherwise….

A newly published prospective, randomized clinical study, which appears in the latest issue of the Archives of Surgery, included two groups of study volunteers. A total of 8 expert laparoscopic surgeons were included in one group, while the other group consisted of 16 university science students. All 24 participants were trained to use a computer-based laparoscopic surgery training device that is routinely utilized to train new surgeons in laparoscopic surgery skills. The science students were then divided into two groups. The “control” group abstained from alcohol for the 24-hour period prior to being tested on their laparoscopic skills, while the other half of the students (the “experimental group”) were allowed to drink alcohol freely until they felt themselves to be “intoxicated.” The 8 expert laparoscopic surgeons were all permitted to drink alcoholic beverages “until intoxicated.” The following day, all 24 study volunteers were tested on the laparoscopic training device at 9:00 AM, 1:00 PM, and 4:00 PM. All study participants also underwent breathalyzer testing to measure their blood alcohol level, and only one of the volunteers had a blood alcohol level above the legal limit (for driving) of 0.1 percent at 9:00 on the morning after their drinking binge.

Among the science students, performance deteriorated in all of the tested laparoscopic surgery skills among those who had consumed alcohol on the day prior to testing (when compared to the “control group” of students). The outcome was not any better for the expert laparoscopic surgeons, either. These experienced surgeons, all of whom consumed multiple alcoholic drinks on the day before testing, showed significant deterioration in the time that it took them to perform specific laparoscopic surgery skills, as well as a significant deterioration in their coordination and in the number of technical errors that they made. Moreover, this significant deterioration in surgical performance was still detectable at 4:00 PM on the day after these study volunteers had consumed multiple alcoholic beverages, and despite blood alcohol levels well below the legal limit for driving.

As previous research with airline pilots has shown, alcohol consumption within 24 hours of performing critical tasks can cause significant cognitive and physical impairment, even when blood alcohol levels are zero, or near zero. The findings of this clinical study of surgeons came to similar conclusions, and these findings suggest that surgeons should avoid the consumption of multiple alcoholic drinks within 24 hours of entering the operating room.

For a complete evidence-based discussion about how to live an evidence-based cancer prevention lifestyle, order your copy of my new book, A Cancer Prevention Guide for the Human Race For the price of a cheeseburger, fries, and a shake, you can purchase this landmark new book, in both paperback and e-book formats, and begin living an evidence-based cancer prevention lifestyle today!

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my new book, A Cancer Prevention Guide for the Human Race,” from Amazon, Barnes & Noble, Books-A-Million, Vroman’s Bookstore, and other fine bookstores!

On Thanksgiving Day, 2010, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books! On Christmas Day, 2010, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list!


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity



Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author



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I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month. (More than 1.2 million health-conscious people visited Weekly Health Update in 2010!) As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.





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Physician Error

 

Welcome to Weekly Health Update


“A critical weekly review of important new research findings for health-conscious readers”


PHYSICIAN ERROR

Ah ne’er so dire a Thirst of Glory boast,
Nor in the Critick let the Man be lost!
Good-Nature and Good-Sense must ever join;
To err is human, to forgive divine.

Alexander Pope (1688-1744)

 

According to the prestigious Institute of Medicine, between 50,000 and 100,000 patient deaths are caused each year in the United States by negligence on the part of doctors, nurses, and other health care providers.  Nearly 1,000,000 patient injuries per year are also attributed to human error in the delivery of health care.

The presumptive causes underlying negligence in patient care are multiple and varied, and continue to be the subject of much debate among patient safety experts.  However, virtually all such experts agree that largely preventable human errors account for the vast majority of patient injuries and deaths associated with negligent patient care.

In the operating room, where I spend much of my time, as a cancer surgeon, we have adopted patient safety “check lists” inspired by the airline industry, and which are designed to reduce the possibility of errors during surgery.  At our institution, the patient’s identity (and the surgical procedure to be performed) is confirmed, twice, by everyone in the operating room before an incision is made.  Towards the end of the surgical procedure, an additional “debriefing” is performed, and the surgeon reviews the procedures that he or she has just performed.  The operating room nurse also confirms that all sponges, needles, and instruments have been accounted for, in an effort to reduce the possibility that any of these foreign bodies will be left within the patient.

 

One important aspect of physician error is that of errors in diagnosis.  In a newly published clinical study, which appears in the current issue of the journal Pediatrics, 1,362 pediatricians at three major academic medical centers, and 109 affiliated clinics, were invited to anonymously complete an Internet-based survey regarding their self-perceived frequency of diagnostic errors.  These doctors included experienced academic pediatricians, experienced community-based pediatricians, and resident doctors who were training to become pediatricians.  Altogether, 53 percent of the queried pediatricians agreed to complete the anonymous survey. 

More than half (54 percent) of these responding doctors indicated that they made significant diagnostic errors at least one or two times per month.  Not surprisingly, the resident doctors in training acknowledged the highest number of diagnostic errors, with 77 percent of these trainees admitting to at least one or two significant diagnostic errors per month.

Based upon their anonymous responses, nearly half (45 percent) of these 726 pediatricians believed that one or more of their diagnostic errors had harmed patients at least once or twice per year. 

When asked to analyze the underlying causes for their errors, these doctors cited the following explanations:  failure to gather adequate patient history information, inadequate physical examination, inadequate review of the patient’s chart, and inadequate coordination of care and communication among the providers involved (“inadequate teamwork”). 

Specific examples of diagnostic errors cited by these pediatricians included viral illnesses being misdiagnosed as bacterial infections, misdiagnosis of medication side effects, misdiagnosis of psychiatric disorders, and misdiagnosis of appendicitis. 

When asked to offer solutions to common diagnostic errors, these pediatricians most commonly recommended the implementation of electronic health records, as well as closer patient follow-up.

(It is important to note that, in view of the human tendency to “under-report” personal failures, it is very likely that the true incidence of significant diagnostic errors is actually considerably higher than what these pediatricians have self-reported in this study.)

 

In a perfect world, we physicians would never make the wrong diagnosis, or miss a diagnosis altogether, or miss an adverse reaction to medications or other treatments.  We would never prescribe the wrong medication or perform the wrong operation; and we would never, through acts of either commission or omission, perform anything less than a perfect surgical operation.  Unfortunately, the practice of Medicine, as with all human endeavors, will never become a “zero error” profession.  However, all of us, both patients and physicians (and physicians are patients, as well), certainly would agree that every effort must be made to drive preventable patient care errors down as close to “zero” as is humanly possible. 

While it is unlikely that human error can ever be completely eliminated, in Medicine or in any other profession, the findings of this important study are significant, and point to areas where substantial improvements in the delivery of health care can be achieved by physicians and other health care providers (and, I might add, by patients as well). 

 

Look for the imminent publication of my new landmark evidence-based book, “A Cancer Prevention Guide for the Human Race,” in August of this year. 



Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author


For a different perspective on Dr. Wascher, please click on the following YouTube link: 

http://www.youtube.com/watch?v=7-Tdv7XW0qg



I and the staff of Weekly Health Update would like to take this opportunity to thank the more than 100,000 new and returning readers who visit our premier global health information website every month.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.



 

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