‘Doctors are not all-seeing all-knowing beings, so challenge us’. -Dr Roddy McDermid.
Healthcare can be confusing, and diagnoses are often questioned. When it comes to health, we want to get things right the first time. Although overall hospital care is excellent, horror stories of poor treatment are the most remembered. A misdiagnosis and incorrect treatment can be dangerous, so it is important to be as sure as possible. So what are your rights? And how can you make sure that you get the best care?
A 2013 article claims that 140,000 cases of diagnostic error a year occur in Australia alone, with death rates of between 2000 – 4000. This may seem a high figure, but when compared with official statistics on admission rates, 8,848,266 cases over 2014-2015, a little less concerning. But even so, every misdiagnosis must be challenged and learned from.
And it seems that you agree. In a recent twitter poll, 65% of respondents agreed that doctors ‘sometimes’ make mistakes. So why do doctors mistakes?
A number of researchers have tackled the problem. A 2014 paper suggests that distracting features in a patient’s story may lead to misdiagnosis, especially when the condition was unclear. Meanwhile other reports suggest that internal ‘anchoring bias’ may blind diagnosis, and that a high case load, stress and time pressure are all catalysts for error. Dr McDermid says:
‘Often there is unfamiliarity with the patient, stress, time pressure, lack of experience, and a need to impress seniors. Doctors that are inexperienced at managing uncertainty often to get it wrong.’
Expressed simply, medicine is a science plagued by uncertainty. Information is often partial, subject to redaction or improvement, and case management can change quickly. Often treatment itself can mask a disease, and another disease hinder treatment. Doctors work on experience and excellence, but any factor that distracts or complicates carries risk.
So how can you reduce your chances of misdiagnosis?
In medicine, information is power. The more you can provide to your medical team about your health, history and concerns the better they are equipped to work with you. To properly provide this information, you need time. And unfortunately, in a busy hospital, this can be tricky. So how can you communicate under pressure and make sure a doctor knows everything? The answer is to be prepared.
By keeping an up to date list of your health conditions, medications and other treatments you can provide a lot of worthwhile information. By creating a list of questions before you see your doctor you can prioritise what matters to you. Have a ‘hospital bag’ ready, with a paper copy of your medical history. This also goes for your concerns, it’s never wrong to ask a doctor ‘Have you considered this?’ or ‘Can you explain?'
A good doctor will never be offended by a critical patient, we respect them. Dr McDermid agrees;
‘Educate yourself. Doctors are busy and stressed and don’t always get it right. Become an expert on your condition. Take ownership of your health. And don’t be afraid to ask us, and don’t be afraid to ask for a second opinion. Challenge us.’
But let’s say even with all this done, you are still worried about your treatment. What’s the next step? Asking for a second opinion. You can ask your doctor for one, and a reasonable doctor will comply. If this is not the case, recent legislation within Queensland allows for an externally moderated system for further referral. By using ‘Ryan’s Rule’ you can access a new, unbiased expert to review your case.
So we know what causes misdiagnosis, how to reduce the risk and how to tackle any concerns. Although misdiagnosis is a reality, it is rare and can be made even rarer. By asserting your rights and taking ownership of your journey, you can be safer. And that is your right.