Wednesday, November 14, 2018

Wisdom Wednesday: Ignoring Patient Input Tied to Diagnostic Error

Patients’ views are not often included in records of diagnostic errors, but new data released today suggest that patient and family narratives may contain key information that should formally be included in the system.

To learn more about how patient experience and patient-physician interactions might affect the risk for diagnostic error, Traber Davis Giardina, PhD, MSW, and colleagues analyzed reports submitted from January 2010 to February 2016 to the nonprofit Empowered Patient Coalition.

The coalition began collecting family experiences to learn more about safety events from the patient’s point of view. Patients, family members, and caregivers voluntarily submit data by responding to questions and adding their own text.

The researchers identified 184 unique patient stories of diagnostic error. Amid those narratives, problems in patient-physician interactions emerged as the major factor in the errors. “Our analysis identified 224 instances of behavioral and interpersonal factors that reflected unprofessional clinician behavior, including ignoring patients’ knowledge, disrespecting patients, failing to communicate, and manipulation or deception,” they write.

About two thirds (67.9%) of the narratives were contributed by female patients, and most of the reported diagnostic errors (79.9%) took place in a hospital. Although more than half of participants said that they had reported the incident either to the institution where it happened or to a governing body, only 9% said they were satisfied by the response, the authors write.

One woman wrote, “I was her first-born child, had worked in a major teaching hospital for years and thought I could manage her care, and make certain she was well taken care of…. I found I was unable to do so, since I was continually ignored…. I failed her.”

In another case reported by a family member, a patient’s reports of abdominal pain that lasted over 3 years were ignored.

“One physician even had the audacity to ‘listen’ to her chest with his stethoscope and NOT put the ear pieces in his ears. Then he patted her on the shoulder and told her she was fine and walked out of the room.” She was later diagnosed with advanced metastatic colorectal cancer.

My Take:
When my patients are not forthcoming with enough history, I often turn to a family member for help. I was taught that “history is 80% of the diagnosis.” To that I add, “Without a history I might as well be practicing veterinary medicine.”

Patients are the only ones living in their body and on some level they always know what is going on. However, they frequently don’t express themselves using language that the doctor understands. It’s up to the physician to assume the patient is right and then try to fit the differential diagnosis to their dialog.

Many years ago a new patient told me she felt “like something is living inside of me.” She had chlamydia, a microscopic STD that is too small to be felt, but it was indeed living inside of her. More recently I had a patient that claimed most days she woke up looking and feeling much older than on other days. I eventually realized that those nights her sleep was not restorative. Once I understood what she was trying to tell me, the solution was easy – Chaste Tree.

Bottom Line:
If your physician doesn’t listen to you, fire them and hire someone else.

Source: November 5, 2018 NIH

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