Readers Write: Lessons From an Emergency Room Nightmare

By Heather Gehlert, AlterNet. Posted December 27, 2008.

Other readers, including some physicians themselves, questioned whether doctors have the adequate time needed to make an accurate diagnosis.

"Appointments to see a primary care doctor in the U.S. are typically 15 minutes in length, during which providers are usually asked to deal with at least three to five  concurrent medical issues," writes mjabele. "This represents all the time given to: 1) listen to and interview the patient, 2) perform a directed physical exam, 3) review the patient's chart, 4) cogitate, 5) order necessary lab work, X-rays, and/or other tests/referrals, 6) write/renew prescriptions, and 7) explain the diagnostic/therapeutic plan to the patient, with sufficient time for questions if the patient should have any. ...

"I think it was William Osler who said, a century or more ago, that '80 percent of the patient's diagnosis comes from the medical history.' I daresay most modern physicians, despite fantastic advances in technology, would agree. But obtaining a good history takes time, and sufficient time seems to be the one thing our modern-day health care system wants to deny us. There's little point in asking questions, after all, if one doesn't really have time to listen to the answers.

"As for 'arrogance,' I wonder how much of what patients perceive is really a combination of the harriedness, anxiety, exhaustion and distraction so many providers feel as they navigate their impossibly packed schedules every day, essentially hoping to 'survive till closing time' without making any major mistakes along the way. I know I've felt that way much of the time; and though I've always done my best to listen, examine, empathize and advise as professionally as the Oath demands, I won't claim there might not have been days when my own patients might have perceived me as more distracted and less caring than I should have been."

"No one can keep up that pace without running on automatic," adds oregoncharles. "That can read as 'arrogance,' which is also fed by the patient's extreme dependence and the doctor's very real superiority in knowledge."

mam01 explains that, in Pollack's case, a wrong diagnosis was likely less about arrogance or time constraints and more about diagnostic methods:

When someone presents with worsening chest pain and elevated cardiac enzymes, a doctor has to make some pretty quick decisions, and it's not unusual to start from the worst-case scenario -- the heart attack -- and work backwards from that.

 

 

Given that a misdiagnosed heart attack has more dire consequences than a viral heart infection, and given that women tend to have more atypical presentations for a MI, I can understand why the diagnosis was made, and I don't believe it has anything to do with arrogance as some comments have suggested.

 

 

Why no one picked up on the error illustrates how we see what we want to see and disregard those facts that don't quite fit. This is even more so when the diagnosis continues to be confirmed by other specialists. That's why it takes someone with fresh eyes and the time to study the chart to see the error.

 

 

And it's why the practice of medicine is both an art and a science.

 

 

While most commenters placed the onus of getting a correct diagnosis on physicians, others said patients, too, should play an important role in preventing medical errors.

"if you have any health issues, it is up to you to gather as much info on them yourself, including medical journals, other relevant articles and a cram course in basic anatomy of your offending body part," writes ellie. "know what the protocol is for all treatment of such offending body part and become a member of your own medical team...

"let the 'professionals' understand that it is your body and you have last word on treatment and options... if they balk, keep on dr. shopping till you assemble a team you can work with and listen to you..."

ladyoracle stresses that second opinions can be critical:

"I was almost released from an ER when I came in at age 28 after coughing up blood after a workout. It turned out that I had pulmonary embolisms, but they only did an X-ray the first time and checked my vitals, and I guess blood, and they couldn't figure out any reason to keep me. so they were going to give me an antibiotic and send me home when I was in pain with every breath. I heard the doctor tell that to my nurse standing a few feet from my room, so I coughed more blood into a Kleenex, but instead of throwing it away like they were telling me, I brought it out there to show it to them. A pulmonary specialist who was there to review a different case overhead me and suggested a CT scan, which then showed the clots. They let me walk to get the CT scan, and then after that I got an IV in the stomach and total bed rest for 48 hours. So, they avoided the mistake that would've probably cost me my life, but they didn't take my blood for the hematologist until hours later, and then more the next day, after I'd already been on blood thinner. My blood showed no abnormalities at that time, but clearly something was amiss, which is another comment for another day. The point is that what saved me is a second opinion."

See more stories tagged with: health, health care, misdiagnosis, diagnostic error, medical mistakes

Heather Gehlert is a managing editor at AlterNet.

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