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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Physicians and Mental Illness

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New research confirms that physicians frequently suffer from mental illness, and are more reluctant than non-physicians to seek help.



PHYSICIANS AND MENTAL ILLNESS

While physicians are less likely than the general population to die from heart disease or cancer, we doctors are significantly more likely to die from suicide than our lay brothers and sisters.  Indeed, a very troubling statistic is that suicide is the second most common cause of death among medical students (accidents are the number one cause of death).

Multiple studies have shown that physicians are at greater risk of developing significant mental health problems when compared to the general population, including depression and bipolar disorder.  Physicians also have higher rates of alcoholism, and other forms of substance abuse, when compared to the general public.  Although the potential reasons behind this higher incidence of mental illness among physicians continue to be debated, most experts agree that doctors with mental health problems are notoriously reluctant to seek help.  They often do not recognize that they are ill, in the first place; and when they do become aware that they are not well, they are less likely than non-physicians to seek professional help.  Moreover, there are still tremendous stigmas associated with mental illness among health care professionals, causing many impaired physicians to avoid reaching out for help.  As if these adverse factors that discourage physicians from seeking help are not already bad enough, most state medical boards require physicians to disclose whether or not they have ever been diagnosed or treated for a mental illness (or substance abuse) as a precondition for initial licensure or renewal of an existing medical license.  (In many cases, disclosing a prior or current history of mental illness, even if the physician is receiving appropriate treatment, can result in very negative professional and financial consequences for physicians who disclose their history of depression or other mental health problems.)

 

 

In view of these disturbing statistics regarding physicians and mental illness, I find the results of a newly published clinical research study to be quite revealing (and disturbing).  In this study, 108 physicians were asked to confidentially complete a 56-item questionnaire that assessed their distress levels and their willingness to accept various forms of assistance for their feelings of severe distress.  This study appears in the current issue of the Archives of Surgery.

Within the preceding year, fully 79 percent of the surveyed physicians had experienced either a serious adverse patient event or a traumatic personal event that left them feeling very distressed.

When asked about their willingness to seek support or assistance regarding stressful issues in their lives, 72 percent of the doctors indicated that they would be willing to seek help for legal problems, while 67 percent would do so after being involved in a serious medical error.  Another 67 percent of the physicians were willing to seek help for substance abuse issues, while 62 percent were open to seeking medical help for physical illness.  Tellingly, only half (50 percent) of the physicians indicated that they would seek help for mental illness, and an equally small number also indicated that they would be open to assistance regarding serious interpersonal conflicts at work.

When asked about barriers to seeking help, 89 percent of the doctors indicated that they did not have time to get help with the causes of their distress, while 69 percent also responded that they were either uncertain about how to get help or that they had experienced difficulty in obtaining assistance.  A total of 68 percent of the physicians also cited lack of confidentiality, a potentially negative impact on their career, and the stigma associated with seeking help as barriers.

Regarding the most likely sources of support that they would be willing to seek, 88 percent expressed a preference for their physician colleagues, while only 48 percent were willing to be seen by mental health professionals, and only 29 percent were open to participating in employee assistance programs.

 

 

The findings of this study are hardly surprising.   The prevalence of major distress and mental health issues among physicians continues to be very high, relative to the general population.  At the same time, only half of the physicians participating in this study indicated a willingness to seek help for mental health problems.  Similarly, only half of these doctors would be willing to seek help for serious interpersonal difficulties (a common marker for certain psychological and personality disorders) in the workplace.  Among the most often cited reasons for not seeking help were “lack of time” and uncertainty about how to obtain help.  Additionally, the physicians who participated in this confidential study expressed serious concerns regarding confidentiality, the potential for negative career impact, and the perceived stigma associated with asking for help for mental health issues.

 

 

From my own experience as a physician over the past 23 years, I can honestly say that these disturbing statistics and findings regarding physician stress, distress, and mental health problems are, if anything, most likely understated.  Within the medical profession, it is no secret that the true incidence of depression, bipolar disorder, personality disorders, interpersonal strife, marital duress, domestic abuse, and divorce is very high among physicians, in comparison to the general population.  Ironically, and unfortunately, however, as bad as the stigma associated with mental illness is in the general public, it is even more severe within the medical profession.

Over the years, I have known numerous physicians with various forms of mental illness and personality disorders, and I cannot recall a single one of them ever voluntarily reaching out to mental health professionals for help.  Sadly, in view of the strong aversion on the part of physicians with mental illness towards seeking help from mental health professionals,  proactive and progressive steps to eliminate the perceived stigma of mental health problems within the medical profession, as well as removing the potentially punitive sanctions that many physicians would otherwise be subjected to if they sought professional help, will be necessary before troubled or impaired physicians can begin to feel free to seek help and support for the problems that torment them.


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 AmazonBarnes & NobleBooks-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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