Getting the Right Diagnosis……….and Not Missing It!

Nancy Muller Health Pro
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    A 1999 Institute of Medicine report estimated that medical errors are estimated to result in between 44,000 and 98,000 preventable deaths and 1,000,000 excess injuries each year in U.S. hospitals. 1  And while there have been disputes about how these calculations were done and their accuracy and even what constitutes a “medical error,” the fact remains that one type of serious medical error happens at the frontend of care, when a patient is misdiagnosed.   

     

    From that point on, there can readily be a cascade of incorrect interventions or decisions, unnecessary adverse events, wasted expenses, and lost time and the possible progression of an unchecked disease or condition.  Even angry emotions and distrust by the patient can erupt, depending on whether the error is disclosed and discussed, destroying trust of the patient in the provider and the health care system itself.  Misdiagnosis of an illness, failure to diagnose or delay of a diagnosis could be a direct mistake of a doctor or caused when the doctor is acting on incorrect information supplied by some other party, such as incorrect or even mislabled laboratory results. But the misdiagnosis can also result from incorrect or incomplete information from the patient.  In fact, The Joint Commission’s Annual Report on Quality and Safety 2007 found that inadequate communication among healthcare providers, or between providers and the patient and family members, was the root cause of over half the serious adverse events in accredited hospitals.2 

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    Even in the “obscure” world of bladder and bowel health, misdiagnosis and failure to diagnose often occur.  In a 2004 nationwide survey orchestrated by NAFC of women living in the community age 18 and older, 20 percent reported symptoms strictly associated with stress urinary incontinence – leaking when sneezing, laughing, or coughing – but who had been prescribed a drug for overactive bladder , resulting in, as one would expect, no effect on their symptoms.    Had these women accurately recorded a bladder diary and shared their experiences to their doctor?  Or instead did they communicate the need to use the toilet frequently, without adding the rationale of trying to prevent an embarrassing amount of urine lost when leaking?

     

    Because the provider fails to ask questions about bowel health and the patient avoids the topic, a  diagnosis of fecal incontinence is more likely to be overlooked.  Is this why there is such a wide gap between the decade old, NIH-quoted prevalence statistic in the vicinity of 2% of the population and more recent clinical assessment that places the estimate at least three times higher, finding that one out of ten women in the general population has fecal incontinence, with one in fifteen of these women suffering from moderate to severe symptoms4 .

     

    Sexual dysfunction, such as dyspareunia, may be even more hidden from providers and therefore left undiagnosed and untreated.

     

    Help your doctor get it right.  Here are some steps to follow:

    1. Get educated.  Read all you can about your symptoms and what you suspect could be your diagnosis…..and the possibilities. And be sure you identify and separate widely held myths from science-based facts.
    2. Get familiar with your anatomy and how it is designed to function.  Know how the part of your body that is giving you symptoms is supposed to work or feel if things are normal.
    3. Keep track of what is happening.  Write down when you experience episodes of pain, discomfort, or other symptoms.  Write down what else you are doing or have just done when the episode occurs.  Record the time, date, and frequency of events.
    4. Learn the vocabulary about your condition and even practice how you are going to describe or express what you are experiencing, particularly if it is embarrassing or uncomfortable, such as pelvic pain during sexual intimacy in the case of dyspareunia or soiled underwear in the case of urine leakage or fecal incontinence.   Our NAFC staff health educator can practice this exchange with you in advance of your appointment.
    5. Find a doctor who is open to dialogue with you and takes the time for this exchange, respecting and wanting your input in the process of both diagnosis and shared decision-making afterwards in developing a treatment plan.  Don’t be afraid to get a second opinion.  And be prepared to change doctors altogether to find one who works with you.

     

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    Nancy Muller, PhD

     

    1Institute of Medicine (199). To err is human: building a safer health system.  Washington, DC:  National Academy Press.  

    2The Joint Commission’s Annual Report on Quality and Safety 2007: Improving America’s Hospitals, retrieved from http://www.jointcommission.org/annualreport.aspx and accessed on July 13, 2012.

    3Hernandez MB, McDonald CL, Gofman Y, Trevil R, Bray N, Hasty R et al. (2010). Physician familiarity with the most common misdiagnoses: implications for clinical practice and continuing medical education". The Internet Journal of Medical Education 1 (2), retrieved from http://www.ispub.com/journal/the-internet-journal-of-medical-education/volume-1-number-2/physician-familiarity-with-the-most-common-misdiagnoses-implications-for-clinical-practice-and-continuing-medical-education.html and accessed on July 13, 2012.

    4 Bharucha AE, Zinsmeister AR, Locke GR, Seide BM, McKeon K, Schleck CD & Melton LJ.  Mayo Clinic Division of Gastroenterology and Hepatology. (2005). Gastroenterology; 129(1):42-49.  

     

     

Published On: July 24, 2012