Misdiagnosis, the Medical Minefield
In 2004, life became a series of doctors’ visits for Mohan*, who suffered from intense shoulder, hip and back pain. The entrepreneur, then 25 and based in Bangalore, could barely stand or walk. He consulted several doctors; no one had answers. Then, one conducted a biopsy and told him he had tuberculosis. Finally, Mohan thought, there was a way forward. For months, he took the prescribed medication—but the pain continued unabated. Slowly, he came to understand that, far from being on the path to healing as he had expected, he had been misdiagnosed.
He started the rounds of doctor visits again.
A whole year after being misdiagnosed – spent in constant pain – another physician, a rheumatologist, finally diagnosed him correctly. With the words ankylosing spondylitis, a form of spinal arthritis most common in young men, Mohan finally started to recover.
Misdiagnosis is always a possibility, even in the most advanced health care systems. But misdiagnosis is a particular bane here, where patient rights aren’t clearly defined and doctors work under severe constraints. A traditional reverence for doctors still permeates our culture, and, combined with widespread ignorance on basic health matters, can set the stage for misdiagnosis.
It’s human to make mistakes, and health care practitioners aren’t an exception, says Dr. Hardeep Singh, a patient safety researcher at the Michael E De Bakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas.
“It’s important to realize that we practice within the constraints of a health care system which affects the way we think and perform,” he says. “Out-patient environments are busy and physicians are performing in time-pressured conditions. Diseases often evolve, rendering the medication that was once used to treat it futile, and diagnosis isn’t as easy as it sounds.”
But when a doctor makes a mistake, it is at best a matter of good and poor health—at worst, a matter of life and death. Studies on primary care, some conducted by Dr. Singh, found that diseases such as cancer, heart attacks, strokes and serious infections, such as meningitis and pneumonia, were frequently misdiagnosed. Conditions such as anemia, dementia, drug reactions and asthma also trigger diagnostic errors, says Dr. Singh.
“In children, our survey of U.S. pediatricians noted commonly misdiagnosed conditions to include viral illnesses diagnosed as bacterial illnesses, appendicitis, side-effects of various medication and psychiatric disorders.”
It’s impossible to guard against a misdiagnosis—patients can’t become doctors overnight, no matter how much Googling we do. But there are some actions you can take to minimize the chance of your malady being misinterpreted.
Choose your doctor wisely
Often, you might be tempted to choose a doctor because of how close his or her clinic is to your home or because his or her fees are more affordable. But when convenience dictates our health care choices, the risk is higher you’ll end up consulting someone whose skill set isn’t right for your condition. Research your medical practitioner online or locally, by tapping friends and family for reviews of his or her bedside manner and credentials. You should always know where the doctor studied medicine, what her specialty is, how long she’s been practicing, and how well patients feel she listens.
If you have a specific or debilitating complaint, consider approaching a specialist rather than a general physician. This can save time, money, and discomfort or pain; specialists are called such for a reason, as they have much more in-depth and specific knowledge, making it easier for them to identify and treat problems.
Ensure your doctor is up-to-date
Sometimes, our own recital of symptoms isn’t enough; doctors require more information to make a more accurate diagnosis. A doctor that is not only willing but able to gather this information is a treasure. For instance, technology that tracks exercising and eating habits, sleep schedule, or reactions to medications can give doctors greater insight into whatever is plaguing you. Doctors can also use technology to consult with far away specialists and make a diagnosis collaboratively.
Communicate symptoms effectively
While access to care is India’s primary health problem, a lesser discussed issue is the amount of time and conversation we have with our doctors. Patients should be spending more time discussing their symptoms and concerns with doctors, says Dr. Singh.
“Many patient-practitioner encounters are rushed,” he says. “Adequate medical history and physical exams aren’t performed, and as a result, diagnosis suffers.”
In some countries, an average consultation will last at least half an hour; in India, it is often a five-minute affair. Avoid doctors who have little patience, who focus more on their busy schedule than you, and who try to rush you out of the consultation room without listening to your symptoms properly. This is especially important if you’ve seeing the doctor with your child, who may need several sessions to warm up to the stranger and who may not be able to articulate symptoms as effectively as adults.
Trust your gut
Checking credentials is fine, but sometimes, even the most brilliant doctors can make mistakes or have off-putting personalities. So, go with your gut instinct. If the answer to any of these questions is ‘no,’ consider finding another doctor: Are you comfortable with your new doctor? Can you confide in her? Does she display sensitivity while listening to your complaints?
One major red flag should be if the doctor tries to sell you something—generally a treatment, medicine or type of therapy he or she has developed. When Latha*, 33, of Delhi, took her 2-year-old to a leading psychologist, she was shocked when the doctor diagnosed her toddler with autism within minutes.
“My daughter is naturally shy, so she didn’t mingle with the doctor much, and went about walking around the room by herself,” Latha remembers. “The psychologist took no effort to get to know her and was only interested in recruiting us into her therapy center. While she told us all about autism, she went on to tell us that ‘such’ kids are ’emotionally sterile,’ cannot be potty-trained without a lot of effort, and basically that our life was going to be hell.”
Get another opinion
While it is fine to respect your doctor, don’t blindly trust her judgment, especially if the medical issue you’re dealing with is complicated, rare, or not improving with treatment. Latha decided to seek another doctor, who gave a different opinion for her daughter—without trying to make a profit.
“Don’t hesitate to seek a second or a third opinion, if required,” she advises.
*Names have been changed to protect privacy.