8 ms·
Most Americans will get a wrong or late diagnosis at least once in their lives
- brunorsini 11y agoA lot of what Google is doing in life sciences has to do with pursuing earlier, more data-driven diagnostics (eg, http://www.wsj.com/articles/google-designing-nanoparticles-to-patrol-human-body-for-disease-1414515602 http://www.wsj.com/articles/google-designing-nanoparticles-t...). I'm sure future humans will be horrified to learn that we walked around with barely no meaningful monitoring on our body stats for our whole lives... Only seeking out help when problems got big enough to be visible to the naked eye or bad enough to impair us.
- powera 11y agoMy TLDR: There may be unknown unknowns in the medical system. It doesn't say how many, it doesn't say the consequences, it just says "most". And since people die, there's probably something we don't know. That said, I'm not sure this problem as described is one that is even conceivably fixable at this scale. As in, I'm literally not sure that a machine that perfectly diagnoses all the health conditions of a person going forward is logically consistent.
- seiji 11y agoI mentioned a few of these the other day: https://news.ycombinator.com/item?id=10240084 https://news.ycombinator.com/item?id=10240084 How do we fix the current system? We could make a global centralized review system for doctors then start maintaing records of performance, mistakes due to just being a "bad doctor," mistakes due to just bad timing (patient complained too late to fix), mistakes due to being overworked ("seeing" 100 patients a day), etc. Even with a global system of reviews and oversight, we'd need a way to evict the failing doctors or reduce their responsibilities. It's a lot like the rampant police violence/corruption problems coming to light now because everybody has mobile video recorders. When everything is hidden, nobody notices and it's difficult getting anybody to believe you about widespread systemic failures. What's the equivalent of a cell phone video for medical malpractice?
- davidw 11y agoI got an asthma inhaler from my family doctor for what turned out to be a collapsed lung, many years ago.
- erroneousfunk 11y agoA few years ago, I was fresh out of college and working at large university with a very good teaching hospital. I was making $30k/year, but had amazing Cadillac health insurance. I started developing asthma (unbeknownst to me. It was caused by a very gradual onset allergy, and I had never had asthma before), wasn't able to walk up a short flight of stairs on my way to work one day, and, instead of turning right to go to the office, I decided to turn left to go to the urgent care center attached to the school. I wasn't waiting more than 5 minutes (for a walk in!), was seen by two doctors and at least one nurse, including a pulmonary specialist, got a chest x-ray, a breathing test, lots of stethoscope exams, and diagnosed (correctly!) with asthma. I don't remember how long I was seen for, but it was a very long time, for what most doctors would probably consider to be a fairly straightforward diagnosis. (Oh! And it was all free -- they didn't even bother to mail me a statement afterwards. I gave them a $20 bill for the co-pay, $5 for the prescription and that was the end of it) Around the same time, a friend of mine, in a different school, going to a not great school clinic with his school's official insurance plan, was in a similar situation to yours, where a collapsed lung was misdiagnosed as "you're just tired, get more sleep," without an exam. (Granted, as an engineering major, he did need to get more sleep, but still!) As you might imagine, there were some pretty hefty hospital bills later on when his condition deteriorated... Anyway, your situation sounds terrible, and I wouldn't be surprised if the collapsed lung misdiagnosis was fairly common. "Collapsed lung" just seems like one of those things that's really easy to misdiagnose (in some presentations, at least) as a number of other things, unless you're good with a stethoscope, and/or have access to medical imaging equipment (and the will to use it!). Ugh. It's so absurd to me how fantastic and thorough my treatment was at one school (I was on the same insurance plan the students were), and how badly the screwed up a similar situation at a school just 10 miles away -- both with nearly equal tuition rates and health insurance plan costs.
- davidw 11y ago
- orand 11y agoOh, us poor Americans! Something tells me this wouldn't be a headline if you replaced "Americans" with "Mexicans" or "Norwegians".
- noir_lord 11y agoAs someone currently dealing with two completely seperate but overlapping medical conditions that have somewhat similar symptoms I'm in a four way battle between what I think, what my GP thinks and what specialist #1 and specialist #2 think. Specialist #1 sent me to Specialist #2 who pretty much dismissed out of hand that the problems where related to his specialism but said he'd do the tests anyway, turns out I do have something that is under his specialism. It's a bit frustrating tbh, the only doctor who's been awesome was the A&E consultant who basically said "this is not normal, march into your GP's and demand the following tests" had he not done that and I not followed his advice I'd still not know what was causing a significant part of the problems I was having nor that certain daily routine tasks could make things horrifically worse.
- calebm 11y agoWhen you see how little time physicians spend with patients, this is not a surprise. Additionally, new research is continually coming out, and the doctors are often not up-to-date on it. This is a huge problem called Translational Research. For this reason, it is important that you do your own research.
- cesarbs 11y agoJust today I went to the doctor and had a bad experience, as it is usual since I came to the US. I basically love everything about living in America. I love this country. But one thing that I don't love here is primary medical care. It is so damn shitty compared to what is was in my home country of Brazil. I don't understand what goes on here. I have to basically convince doctors to examine me. They treat me like they're doing me a favor. I'll usually leave the office with a recommendation to take ibuprofen or a prescription for antibiotics, and most of the times that doesn't address my concerns. Also, doctors here have this huge attitude that I don't recall ever seeing on a Brazilian doctor. I can't fathom how the country with the most advance medicine in the world does so bad on primary care.
- yourapostasy 11y agoThis is an artifact of the medical insurance system in the US, which focuses upon low-cost, high-volume processing of patients and gouging the delivery staff on payments. Subscribe to an expensive concierge physician service (the kind that is cash/check/bank-transfer only, no insurance allowed, some don't even take credit cards), and the difference is night and day; impeccable bedside manners, no rushed visits, 24x7 phone access to your personally-assigned doctor (with only light screening by the RN on duty, if any screening at all), some even perform house calls. It is no secret that if you are well-to-do or wealthier in the US, then it offers you some of the best medical services and quality delivery you can buy anywhere in the world; the steady stream of medical tourism by the very wealthy non-US patients year-in and year-out attests to that. And if you are not so well-off in the US, then any complex medical complications requiring sophisticated treatment to survive can be a horrifically terrifying experience, depending upon your individual roll of the dice in our byzantine insurance maze. While many US citizens decry "socialism" when single-payer systems are discussed, I personally believe Coase's Nature of the Firm might offer one possible solution set out of many possible such sets, in terms of a solution along the lines of co-ops.
- donnfelker 11y agoDoctors "practice" medicine. Know one knows it in and out. Remember that next time you get a diagnosis. "Doctors practice medicine."
- 27182818284 11y agoWhen doctors "practice" medicine they aren't saying "We're amateurs just like band practice." They're just using the traditional wording. You also here this with other older professions like law. http://www.etymonline.com/index.php?term=practice http://www.etymonline.com/index.php?term=practice
- kmug 11y agoBodies are pretty complex systems to diagnose. We ask programmers to work in pairs to reduce mistakes and then trust our lives to a single opinion. Buyer beware if you're not getting second opinions.
- DinkyG 11y agoThis. There is also a pretty wide variation in skill levels between different doctors. With only one arbitrarily selected opinion the chances of getting advice from the wrong end of the spectrum is higher.
- shostack 11y agoWhat is frustrating is cases where doctors insist they are right, and how dare you the patient question their expertise based on your internet research. I mean, look, I totally get their side--you are paying them for their knowledge which they accumulated from years of practicing and years of specialized training. You SHOULD largely trust them. But doctors are also often overworked, and may not always specialize in your particular area. You also obviously have a much more vested interest in the outcome as a patient, so there's a decent chance you'll spend much more time researching it than your doctor. All of this to ask..."how can we strike a balance?" If one has doubts about what their doctor is telling them, they can always get another opinion. I just wish there was a better way to vet any research one might do on their own without the doctor getting upset that you continued to look into the matter instead of just taking their word on it when things don't improve. Personally, I have an awesome doctor, but when I have these concerns I preface them by saying "I recognize this is internet research, and I trust your opinions on these things, but I had X, Y and Z questions." They have always been perfectly happy to answer my questions and address my concerns (as I would hope given what they bill my insurance for a 15 minute visit...)
- aantix 11y agoWhy worry about offending them when it's your life on the line? You're paying them.
- whyenot 11y agoI will never fully forgive the nurse who informed me in 1998 that I had AIDS and that I needed set up a living will and get my affairs in order before I began experiencing "cognitive decline." It turned out I didn't have AIDS but a highly treatable parasitic infection from time spent working in the Amazon.
- mfoy_ 11y agoI can only image that roller coaster... How long did you think you had AIDS for?
- gohrt 11y agoWhat did the nurse do wrong?
- DanBC 11y agoGerd Gigerenzer talks about medical testing, and the scary numbers of health professionals who are unable to interpret the results. https://plus.maths.org/content/reckoning-risk https://plus.maths.org/content/reckoning-risk This is what most people struggle with: > The probability that one of these women [asymptomatic, aged 40 to 50, from a particular region, participating in mammography screening] has breast cancer is 0.8 percent. If a woman has breast cancer, the probability is 90 percent that she will have a positive mammogram. If a woman does not have breast cancer, the probability is 7 percent that she will still have a positive mammogram. Imagine a woman who has a positive mammogram. What is the probability that she actually has breast cancer? That can be reworded to something much easier: > Eight out of every 1,000 women have breast cancer. Of these 8 women with breast cancer, 7 will have a positive mammogram. Of the remaining 992 women who don't have breast cancer, some 70 will still have a positive mammogram. Imagine a sample of women who have positive mammograms in screening. How many of these women actually have breast cancer? It's a good book and covers cases of misdiagnosed HIV. http://www.amazon.co.uk/gp/aw/d/0140297863 http://www.amazon.co.uk/gp/aw/d/0140297863 http://www.amazon.com/gp/aw/d/0140297863 http://www.amazon.com/gp/aw/d/0140297863
- mcshicks 11y agoIf you find this article interesting you might consider the book "How Doctors Think". It's basically an entire book dedicated to the subject of misdiagnosis and how our modern medical system has some systematic flaws that contribute to it. If I think about just how often I'm incorrect in trying to diagnose an electronics or software problem, and how little time an average doctor spends on a problem, it's not surprising to me that anything that is remotely outside the norm could be easily misdiagnosed. For me the takeaway is to just accept that for common problems doctors can do a great job, but if you have a condition that is not making progress despite seeing a doctor be open to the fact their diagnosis could be incorrect. I had a minor problem with my ears a few months ago, went to a doctor, was given a diagnosis and treatment which temporarily improved the condition but did not seem to eliminate it. Went to another doctor a few weeks ago, given a different diagnosis and treatment. There you go. https://en.wikipedia.org/wiki/How_Doctors_Think https://en.wikipedia.org/wiki/How_Doctors_Think
- vladimirralev 11y agoIsn't this normal, expected and sort of by design for any non-trivial diagnosis? https://en.wikipedia.org/wiki/Differential_diagnosis https://en.wikipedia.org/wiki/Differential_diagnosis Doctors know they are wrong all the time, but they must keep the cost of testing to a minimum while considering the more life-threatening possibilites first.
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- asdfologist 11y agoSo how did you ultimately find out about the esophageal stricture? A third doctor?
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- tjradcliffe 11y agoThis story is a textbook example of bad reporting. The headline and opening paragraph combine two completely different categories of error--"wrong" and "late"--so that it is possible to say "most Americans". The story then goes on to talk exclusively about "wrong" as if that was the dominant category. "Late" is never mentioned. The abstract of the ($60) report talks about errors only, but reading between the lines "late" is subsumed under the author's notion of "error". So this story tells us nothing about the actual rate of misdiagnosis, but it leaves unwary readers with the probably false impression that "most Americans will experience misdiagnosis". This is not to say that misdiagnosis is not a serious problem. But then, so is really bad reporting.
- frederickf 11y agoIn my totally unauthoritative opinion the diagnostic process has been optimized to find the most likely cause as quickly as possible. This isn't a terrible strategy on the aggregate. It increase the overall likelihood that the most people will get the right diagnosis. But the trade-off is that some people will get the wrong diagnosis. The alternative would be for doctors to spend more time really digging into symptoms and tests to ensure they get it right the first time, every time, but then fewer people would get diagnosed. This would be okay if doctors would accept the limitations of the system and admit when they don't know the correct diagnosis or are not sure. In that case they would say something like "This is the most likely diagnosis, but it doesn't meet your symptoms, you should seek a specialist" or something to that effect. I think what happens too often is that doctors confuse the most likely diagnosis with the correct diagnosis, possibly because they're unwilling to admit their fallibility.
- petra 11y agoThis is an area, that currently available IT technologies could be of great help - if they were seriously deployed: First, automated medical questionnaires before the visit can gather much more detailed information that a doctor in such a short visit, and display it to the doc in an efficient manner, while letting the doctor verify or ask more. There's a company doing this via tablets at clinics, forgot the name. Second, medical expert systems(like Isabel healthcare) that could manage the extreme complexity of Healthcare, request missing data, offer an accurate list of possible diagnoses with probabilities without forgetting rare diseases. Basically Dr. House in a box. But, I fully expect doctors to resist those systems, like in the past, because it takes away from their skill and makes their work boring. But maybe we as consumers should demand this, both through the political process and through our consumer power?
- greedo 11y agoFalse positives and false negatives are no fun. I presented with rather obvious signs of colon cancer, but due to my age and lack of family history, my GP misdiagnosed it as irritated hemorrhoids. A year later, I went back to him and he decided he better refer me to a specialist who diagnosed me with a 6cm tumor. Luckily that thoracic surgeon was pretty damn good at his job, and I'm here 10 years later to write this post. Sometimes medicine is an easy diagnosis, sometimes outliers bite you in the ass...
- bsder 11y agoHow many of the people here react positively when members of their family share their "internet computer experience" when trying to fix a computer? Yeah, thought so. Now, let's move on to the fact that the patient is saying "fix me" while the doctor is operating on "First, do no harm." Now, translate that to some individual who is actively having a health problem that may be dangerous. But who doesn't want to hear things like "stop smoking", "stop drinking" and "get exercise" and wants a pill. Now, add in people actively trying to scam you to get prescription medication. Now, some people simply want to be told completely what to do because they don't have the capacity to make the decisions for themselves (cancer diagnoses in particular bring this out). Finally, doctors are human and are sometimes having a bad day. etc. Dealing with people sucks and is an art rather than a science. My experience with doctors has been this: if the doctor won't explain his reasoning or it isn't logical, I'm getting another doctor. This cleans out the idiots and the assholes. The flips side is that if the doctor IS explaining something to you: shut the fuck up and listen. The quickest way to leap up the communication scale is to be so informed about what's happening that you can ask intelligent questions about the situation after an explanation. Just remember, doctors are running with the probabilities. A well-informed, logical patient is almost as improbable as an Ebola diagnosis.
- medicalskeptic6 11y ago>How many of the people here react positively when members of their family share their "internet computer experience" when trying to fix a computer? Yeah, thought so. The difference is that people actually respect doctors and usually do what doctors tell them to--baring lack of money, time, or willpower, or some other quack like Andrew Wakefield telling them not to. Technology professionals by contrast aren't respected, and our advice (like "keep your software up to date") is often simply ignored regardless of how much we repeat it. >Now, let's move on to the fact that the patient is saying "fix me" while the doctor is operating on "First, do no harm." They're operating on "first, make as much money as we can." If they weren't, then medical bills wouldn't be the #1 cause of bankruptcy in the US. >Now, add in people actively trying to scam you to get prescription medication. Many countries (particularly in Latin America) don't allow doctors to act as gatekeepers to medicines and allow you to legally purchase almost any drug, with or without a prescription. To require otherwise is simply rent-seeking under the guise of protecting people from themselves. >Just remember, doctors are running with the probabilities. and running with scissors in the dark, apparently: http://slatestarcodex.com/2013/12/17/statistical-literacy-among-doctors-now-lower-than-chance/ http://slatestarcodex.com/2013/12/17/statistical-literacy-am...
- JoeAltmaier 11y agoIts Occams Razor. There's never any point in a diagnosis other than the most common problem that shares your symptoms. Nobody is doing much to weigh the risks of false positive/negative vs each diagnosis' life-threatening properties. Even if they did, they'd have to measure life in dollars (the cost of tests etc) which is a losing game no matter how you play.
- andrewl 11y agoPaul Graham discussed this in the Ongoing Diagnosis section of his Frighteningly Ambitious Startup Ideas article at: http://www.paulgraham.com/ambitious.html http://www.paulgraham.com/ambitious.html