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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New Study: Medication Errors Linked to Half of All Prescriptions








 

A new study shows that despite increased efforts by hospitals and pharmacists, half of all new prescriptions, on average, contain at least one error.


 

NEW STUDY: MEDICATION ERRORS LINKED TO HALF OF ALL PRESCRIPTIONS

The prestigious Institute of Medicine estimates that at least 1.5 million medication-related cases of injury or illness, also known as adverse drug events (ADEs), occur each year in the United States, and that, on average, hospitalized patients can expect to experience at least one medication error per day.  Because of this very large number of ADEs, and their potential to cause serious harm to patients, several strategies for reducing ADEs have been recommended, including improved communication between doctors, pharmacists and patients; the use of electronic medical records and “e-prescriptions” that incorporate medication screening software; and improved drug labeling and packaging practices.

Despite these recommended strategies for reducing ADEs, a newly published prospective, randomized, controlled clinical research study suggests that even more effective strategies need to be identified, and implemented, if we are to significantly reduce ADEs caused by medication errors.  This new clinical study appears in the current issue of the Annals of Internal Medicine.

In this new study, two large teaching hospitals in the United States randomized patients being discharged after admission for heart-related illnesses into one of two groups.  One group, the “control” group, had their discharge medications prescribed and monitored in the usual manner.  The other group, the “intervention” group, had their discharge medications managed using an enhanced approach to medication prescribing and monitoring, including having a pharmacist directly review patients’ preadmission and discharge medications, one-to-one patient counseling by a pharmacist regarding their medications while patients were still in the hospital, the provision of extra counseling and assistance for patients with literacy challenges, and individual patient follow-up by telephone after their discharge from the hospital.  All patients in the intervention group were provided these enhanced services for 30 days from the date of their discharge by these two well known academic medical centers.

The results of this important prospective clinical study were, unfortunately, rather discouraging.  Among the 851 volunteers who participated in this study, 432, or 51 percent, experienced one or more clinically significant medication-related errors, 23 percent of which were assessed to be serious errors, and 2 percent of which were considered to be life-threatening errors.  Regarding ADEs, specifically, 30 percent of the patients in this study were confirmed to have experienced an adverse physical reaction or complication associated with their medications, while another 30 percent experienced abnormal symptoms or side effects that were deemed to be “potential” ADEs.  When the researchers compared the two groups of patient volunteers in this study, they found that the intervention group patients, who had received extra medication prescribing and monitoring safeguards, had the same incidence of overall medication errors and confirmed ADEs as the control group patients, unfortunately.

The findings of this clinical study are, needless to say, very disappointing.  Despite the best efforts of these two large teaching hospitals in taking multiple extra measures to drive down the number of medication errors and ADEs, these enhanced efforts appeared to have had no significant beneficial effects.  Indeed, half of the patients participating in this clinical research study experienced one or more medication errors, and proactive health-literacy-directed and pharmacist-delivered interventions appeared to have no impact on this very high incidence of medication-related errors.  (You can also bet that the incidence of medication errors and ADEs are likely to be much higher in many hospitals and pharmacies that are not closely following their patients within a rigorous prospective clinical research study, such as this study.)

The findings of this important prospective clinical study strongly suggest that currently available recommendations for addressing the ongoing high rate of medication-related errors and ADEs are likely to be inadequate, particularly for patients who are transitioning from the hospital to home.  This study’s results also indicate that additional new strategies need to be quickly identified and implemented.  At this time, I urge all patients to proactively review both their current and new prescriptions with their health care providers, and with their pharmacists, in an effort to detect potentially serious medication-related errors before they can cause any ADEs.  Moreover, every one of us who take medications (including vitamins and supplements) should carry an updated list of all medications, and a list of any allergies or sensitivities to medications, with us at all times.



At this time, more than 8 percent of Americans are unemployed.  According to the Bureau of Labor Statistics, however, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is now 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 urge you to hire a veteran whenever possible.


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.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


 

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 1.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious people who visited Weekly Health Update in 2011!)  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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