Causes of Misdiagnosis in 21century

Introduction.

Really there is nothing to get surprised of hearing about misdiagnosis or misdiagnosed diseases in  21^st century. Misdiagnosis simply means a doctor wrongly identifies your disease. Very bad isn't it? It may not be your fault so do not worry and at a certain point once in a while many patients have gotten a misdiagnosis. It does not matter which nation be it India, Zambia or any other country with advanced equipment or specialists, misdiagnosis exist. To make the matters worse Doctors are a busy group of people. But do you agree that should make you wrongly diagnosed just because doctors are busy people? No. There are serious and inevitable reasons sometimes leading to a doctor diagnose your condition wrongly, in fact no single doctor loves to make a wrong diagnosis. It really pains a lot and feels bad. Clinicians are always studying and practicing just to make sure they make correct diagnoses of conditions brought with their clients. 

There so many factors leading to an establishment of wrong diagnosis and these reasons varies from patients themselves, the doctor, and the facility factors. You may agree with me that not all the people are able to afford expensive tests, and not only that some errors exists in these medical equipment we use for patient diagnosis. The process of finding out the condition leading to a patient's symptoms is what we call diagnosis or Troubleshooting as what my friend Gulshan could call  it. This process may sometimes be complicated depending on the condition a patient came with.

Normal diagnostic process

Normally the process of reaching a diagnosis  requires a team ranging from the doctors (general and specialists),radiology,microbiology,biochemistry,hematology, electrocardiology and relevant teams from different departments. A patient passes through registry department where the demographic data is collected through computer or paper written. from there a patient goes to see a doctor where vital and other data is taken and recorded in preparation for an interview. depending on the condition a doctor may order investigations to identify  the cause of patient's symptoms. sometimes conditions are diagnosed clinically and n need of a lab test. it that case a patient will go for drug supply from the doctors office. If not the process will involve the laboratory to help and that is where some errors may even go up.

Causes of misdiagnosis

Patient factors

Some diseases that affect to a particular age category/range and if you lie about your age as a patient it may make a doctor miss the diagnosis though rare. When visiting a doctor make sure you know exactly the changes that you have noticed with the current condition that information is critical when differentiating the diseases that present with same symptoms. Tell your doctor right age, all the symptoms, the mood changes associated with the symptoms and the medication or medical conditions that you may have already. failing to answer correctly to any of these when asked by the doctor may gift you with a wrong diagnosis. Sometimes patients agree to a condition that they have never suffered before and it may alter a clinical decision

There are so many causes of to why patients lie to their doctors and this may include stigma, privacy issues, the nature in which the problem came etc. Some of the reasons are known by individual patients. my advice is that do not hide from a doctor anything that concerns your condition.

Doctor factors

These factors can be categorized into:

Identical symptoms on different medical conditions.

There are what we call differential diagnoses and a doctor may mistake symptoms of  condition  A for condition B. For example, tonsillitis (swelling of tonsils) can present in the same way as viral pharyngitis especial when  tonsillitis is just beginning. 

Major and minor health conditions can have very similar symptoms that can sometimes confuse a doctor. Doctors will do no further testing if they believe that the condition is a minor one when in reality it was a serious problem. By doing so, a misdiagnosis and lack of treatment can result from the doctor’s negligence to order the proper test. It can often time be too late for the patient because they might have had a critical condition where time was of an essence. 

Insufficient knowledge or  updates on new medical conditions

There is almost-always a trend of  new conditions coming both infectious and non infectious such that some doctors may not have been updated on them. Just imagine you were the first covid-19 patient and no Doctor knew about it.
Tens of thousands of conditions can possibly affect a human although a person seeking medical assistance expects a doctor to know all the types of diseases that are present. There are some mysterious and advanced diseases that doctors are not fully aware of. Due to the lack of knowledge about these diseases, doctors may confuse symptoms of that mysterious disease and diagnose it as being another disease or medical condition that occurs more often. Doctors need to test thoroughly when a person is diagnosed with a disease because many diseases share similar symptoms.

Ordering of wrong investigative tests.

Sometimes due to incompetence or sometimes just because a doctor had a different view on the symptoms he may order wrong investigations.
Doctors tend to order certain tests depending on the symptoms that are being described by the patient. Underlying issues can go unnoticed if the proper tests are not ordered. A disease can be completely missed when a doctor just orders a test due to specific symptoms that the patient is describing. Performing the most tests as possible is essential for a doctor to do when trying to figure out what condition the patient has.

Laboratory factors

The things that can make a patient be misdiagnosed includes equipment and the laboratory personnel. Doctor and the makers of diagnostic equipment are all human being so give it an allowance for some errors.

Lab personnel 

Not really negligence but just the sample brought was not well collected and it could end up being contaminated by another organism so the test end up detecting the ghost organism instead of negative results you get a positive one. Mean while the patient do not have that pathogen in their body. what will happen? wrong medication and no improvement on  patient's condition. yes such things it happens.

The other issue is that the  laboratory personnel isn't competent with the type of the test needed. The doctor will end up getting wrong results and diagnose wrongly. you now see that a hospital setup is same as the community where every member has a part to play and if a wrong thing is done  can affect the whole system. Never blame the doctors alone. sometimes it can just be an error with the personnel.

Did you know that some test results changes depending on the time the lab personnel saw them? when the instruction says read results after 15 minutes it should be followed or else you get wrong results after that time elapses. 

There are Sonographers that are good at interpreting the machine and will write a good report to the doctor. Now what if  he is not good at it? normal fluid collection on some body cavities will be termed as abnormal hence wrong report to the doctor and wrong diagnosis. 

Lab equipment 

Even if we have advancement in lab equipment in this technology era still there are a small percentage of errors in the equipment we use. for example using a sphygmomanometer to take blood pressure csn give a result slightly different from thta of a digital BP machine. Doctors can agree with me on that and especially if the digital machine is not serviced.Equipment can

Commonly misdiagnosed diseases

Cancer

According to the Journal of Clinical Oncology, cancer misdiagnoses occur as much as 28 percent of the time, and up to 44 percent for some types of cancer. A nationwide survey of 400 cancer specialists found that leading the list of most misdiagnosed cancer conditions are lymphoma, breast cancer, sarcomas and melanoma. The reasons for misdiagnosis include fragmented or missing information, inadequate time for patient evaluation, and incomplete medical history.

Heart Attack

What a heart attack feels like can vary, and sometimes people have few if any symptoms at all. “Older people don’t always have the same symptoms as younger people do, so a young person may have crushing chest pain, and an old person may not feel anything or say I have a little indigestion,” Dr. Graber says. Women having a heart attack are more likely to be misdiagnosed because they often don’t experience the classic symptom of chest pain, according to a 2014 study.

Depression

Common symptoms of depression include feelings of sadness, anxiety, and irritability. People with depression may experience chronic fatigue, concentration issues, and sleep problems. These symptoms can be vague and overlap with other conditions such as bipolar disorder, anxiety disorders, and post-traumatic stress disorder. “Diagnosing depression requires a complete history and physical exam,” says Richard Shadick, PhD, associate adjunct professor of psychology and director of the counseling center at Pace University in New York City.

Celiac Disease

“About 83 percent of people with celiac disease are either still undiagnosed or have been misdiagnosed with other conditions,” says Rachel Begun, MS, RDN. “The reason is the symptoms for celiac disease are many and vary widely from person to person.” The symptoms commonly include abdominal pain, constipation, and diarrhea; but people may experience headaches, joint pain, or depression. “Some people have absolutely no outward symptoms at all, making it particularly hard to diagnose,” says Begun. Celiac disease is most often misdiagnosed as irritable bowel syndrome.

Stroke

“Doctors overlook or discount early signs of potentially disabling strokes in tens of thousands of Americans each year,” according to researchers. The American Heart Association found that young adults with stroke symptoms are often misdiagnosed with vertigo, migraine, or alcohol intoxication. Regardless of a person's age, stroke symptoms such as vision problems, confusion, severe headache, numbness of the face, and trouble speaking or walking require immediate medical attention.

Lyme Disease

A bacterial infection caused by a tick bite, Lyme disease can cause symptoms like muscle and joint pain, fever, stiffness, and fatigue. The primary symptom is a rash, but not everyone develops one. “On average, people struggle for 1.2 years before they are accurately diagnosed with Lyme disease,” according to a 2005 study.

Fibromyalgia

This chronic condition is characterized by widespread muscle and joint pain, fatigue, anxiety, and sleep issues. It is commonly mistaken for rheumatic diseases such as rheumatoid arthritis and lupus, and chronic fatigue syndrome. Risk factors include a history of rheumatic disease and fibromyalgia in the family. Fibromyalgia is more common among middle-aged women.

Thyroid Conditions

A common cause of hormonal imbalance, thyroid disease can trigger production of too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism). The thyroid hormone is an essential part of metabolic processes in your body, so unbalanced levels can cause symptoms such as weakness and fatigue, fluctuations in weight, and muscle pain. These symptoms may be mild and can be mistaken for other conditions including depression.

Aortic Dissection

When there’s a tear in the wall of the aorta, blood rushes through and forces layers of the aorta to separate. “An aortic dissection, which can be fatal, has to be diagnosed very quickly, but it can present in dozens of different ways,” says Graber. “It can be very misleading and can confuse the doctor you’re seeing. As a result, they don’t do the correct tests quickly enough, and then you’ve got a diagnostic error.” A 2009 study found that nearly a third of patients suffering from aortic dissection were initially misdiagnosed.

Pulmonary Embolism

Usually caused by a blood clot, pulmonary embolism is a blockage of the pulmonary artery, the main artery in the lung. Symptoms include sharp chest pain, shortness of breath, fainting, and anxiety. A 2013 study found that 33.5 percent of patients with pulmonary embolism were sent home or admitted to hospitals with a wrong diagnosis. Pulmonary embolism can be mistaken for other conditions such as a heart attack or pneumonia.

Effects of  Misdiagnosis

28% of misdiagnoses are life threatening or life changing.

• Wrong prescription of drugs.Honestly the effects can range from mild to severe. Drugs are curative but sometimes can give side effects and what if you are given wrong prescription? you lied that you do not take some certain drugs and the doctor gives you the contraindicated drugs.
• Stigma. some conditions can make one feel stigma am sure you know what  those diseases are. what makes Mr A  feel stigmatized may not be the same with Mr B.
• You may waste money.Some diseases are expensive to treat and may cost you alot of money than the actual disease would.
• Lost of trust to the hospital.This one affect the hospital  that made a wrong diagnosis. Once you discover you were misdiagnosed, can you go back to the same hospital? I do not know that depends on you because sometimes it can be a simple error than the big things a doctor has done for you.
• Death
• Emotional and mental trauma

Statistics for wrong diagnosis 

• 12 million of adults are misdiagnosed every year
• 10%-20% are patients with serious conditions
• 44% of some cancer types are misdiagnosed
• 51% of breast imaging second opinion results into big change of interpretation

Helping a doctor make a right diagnosis

• Do not lie about your data. Age,social data: you smoke or not, you drink alcohol or not, married or single. All that is important even if they sound simple and silly.
• Tell your doctor about the drugs you take, prescribed or the recreational drugs. 
• Tell your doctor everything about the current medical or surgical conditions or any. Include details of the operation you had and what lead to it.
• Ask questions that may help you give him more data about your conditions and also to make you clear.

Conclusion

Having known all the causes and the modalities of diagnostic process you may wonder who brought about the wrong diagnosis you where baptized with.Be free to ask what  further information the doctor may want to know about you. Choosing which hospital or lab has the best  medical  diagnostic services is cardinal in preventing misdiagnosis