Can patients influence diagnostics?
When I asked this question via social network, I have received the avalanche of fuming responses from medical professionals. The majority found the question ridiculous. Of course, patients have an influence. It is their symptoms that are studied, their blood that is examined, their vital signs that are measured to ultimately pronounce the diagnostic verdict. But should patient have an opinion in this process?
One of the straightforward responses runs as follows: Patients lacks objectivity and/or rational understanding. Their feelings and emotions are too subjective.
It isn’t the responsibility of a doctor to teach a patient WHODAS 2.0, tests and measurements or Diagnostic criteria contained in the DSM V.
It follows from the statement that a patient should continuously remain the passive object of medical examinations.
But what if a patient is confident that the verdict is wrong? Not only misdiagnosis can stigmatise an individual by ascribing anomalies she/he never possesses, but also provoke consequential medical mistakes based on initially wrong assumptions. Diagnostic errors are one of the major life-threatening diseases causing the death of seventy-one thousand and four hundred Americans annually. According to the Society to Improve Medical Diagnosis 2017 Annual Report every one in 10 medical diagnosis are incorrect (ten per cent).
To set up a correct diagnosis is unquestionably difficult. After all, with 10.000 known diseases any one symptom can have hundreds of possible explanations. The problem of diagnostics is mathematically related to a class of inverse problems which are the most intricate in science. But the worst scenarios are when misdiagnoses are determined not by the complexities of the subject, but by calculative, administrative, financial or logistic priorities.
Here are some stories told by the „emotional„ patients “with the lack of understanding”. For the privacy reasons let us call them Jack and John.
Jack, who had a long history of neurological and cardio disorders was delivered to the hospital with a strong vertigo, vomit and minor speech disorders. Unfortunately, this episode overlapped with the flue epidemy in Europe, so most of the hospitals were “fully booked”. One had to have a really good reason to occupy a bed for a few nights. The CT showed signs of the “old stroke” that took place a few weeks ago. From a medical perspective, nothing more to do. But the symptoms stubbornly continued and required an explanation. Jack was sent to an otolaryngologist. The solution was immediately found. In 10 minutes Jack was diagnosed with “Neuritis Vestibularis” also known as Labyrinthitis or inner ear inflammation. Inner ear is an important part of the vestibular system which sends signals to the brain about body location in space. Its inflammation may result in a sensation of the world spinning. In two days Jack was discharged from the hospital with the prescribed dosage of cortisone. The hospital bed was free to accept another misfortunate.
They family asked for the second opinion. None of the otolaryngologists they talked to confirmed the diagnosis. Occasional slow of speech clearly indicated that vertigo had a more serious neurological background. Three weeks later Jack was brought back to the same hospital with a missed stroke. Physicians who examined him at the Emergency Ward and saw the previous diagnosis pronounced only one word: Rubbish!
Nevertheless, Neuritis Vestibularis is still migrating from one medical record to another whatever medical institution Jack is visiting. Moreover, since Jack was a diabetic the huge dosage of cortisone provoked the dramatic increase of his sugar level.
Another story could have had even more dramatic consequences. After heart OP (two bypasses) John was transferred to Intensive Care Unit (ICU). His conditions at that time were considered stable. He was communicative, welcomed visitors.
On the second night after the OP he was left in ISU with two nursing apprentices on duty. According to their story told later the patient attempted to take off the oxygen mask and “could have damaged himself”. Apparently, they were not listening to what John was trying to tell them: there was no oxygen in the mask and he was simply suffocating. The two strong young ladies, assisted by a belligerent staff nurse who obviously knew nothing of the case but was a priori hostile to the patient, jumped on the half-paralyzed man knotting him to the bedside to reliably interrupt his protests preventing him from pressing the emergency button. The subdermal injuries caused by fastening John were so hard and the tissue damages and bruises so deep that one of his hands was damaged forever.
Attracted by the midnight noise another patient jumped out of his bed attempting to help his roommate by calling the police. He was running along the corridor with a rubber tube hanging from his side until he was caught be the alarmed nurses who were chasing him with wild cries.
One could imagine such scenes in the Woody Allen movies, should it not actually have happened in one of the most prominent hospitals in Germany. The family expected at least an apology. Instead , John received a note in his records that he was mentally and emotionally unstable. This phrase could have followed him throughout his life, although he knew nothing of the vicious record. There was no mechanism for relatives to dispute the verdict that simply disguised hospital’s self-protective lies. Thanks God, a doctor from Rehabilitation Centre who treated John later simply erased the stigma from his records.
A friend of mine, a cardiologist from one of the reginal clinics in Germany, too young to be interested in hospitals’ „hidden agendas” and other corporate priorities alien to patients’ well-being, once complained to me that he actually was given only two or three minutes to examine a patient. He had to perform multiple tests for several people literally running from one examination room to another: ultrasound, ECG, ECG, CT, sonography, etc.
Once he was examining a patient who, from his perspective, had clear clinical indications for thrombosis. However, the CT scan showed no thrombus. My friend had requested his supervisor to give him more time to complete the examination. The response was: “Do your job immediately. Time is money. There is nothing on the screen, so we are clean. Move on.” Apparently the focus in the hospital was more on profit based on “volume” rather than on the optimal patient care.
Thanks God my friend ignored the instructions and continued the examination. He finally found the thrombus. Should the patient be dismissed from the hospital, he would have been dead in a few days.
The law-enforcing agencies, the police included, are generally reluctant to get involved in the cases with medical staff, no matter how grave the damage presumably were.
“There is no way patients can protest – the young cardiologist added bitterly. – You can even call the police, but they will listen not to patients, but to physicians.”
As patients and citizens, we do understand that misdiagnoses can happen. After all, we are all humans. Doctors can be tired, stressed, exhausted. But the society should not tolerate wrong diagnostics, lies and negligence intended to cover hospitals’ administrative or financial needs.
Patients are the only ones who have uncompromised and unbiased interest in correct diagnostic. Unfortunately, today they have very limited control over negligent behaviour, misdiagnosis and their devastating consequences. Can this be changed?