Misdiagnosing Scotland.

by endlesspsych

I suspect this may turn out to be a busy week of blogging. Given I plan to do a piece on “remote viewing” to continue to analyse and look at Derren Browns events and recent news means the piece on torture I have been working on for quite some time is now fairly relevant.

All that, hopefully should be, to come but today your getting my take on an issue that I perhaps feel new qualified then usual to tackle. (No links today blogging from phone unfortunatly – edits will follow most likely tomorrow, formatting will probably also be gloriously skew whiff, sorry!)

This post concerns a BBC scotland report which found:
“Hundreds of thousands of people could be misdiagnosed by doctors in Scotland every year, a BBC Scotland investigation has revealed.
Medics could be getting it wrong in as many as 15% of patient consultations in hospital and primary care.
But cases of misdiagnosis, which do not all result in harm to the patient, are not recorded anywhere in the NHS.”

What I get from this story is that “misdignosis is bad” and perhaps the inplication, I may be reading this in to the story myself but given the medias prediliction for sensationalism…, that these things are perhaps being covered up…

I agree that misdiagnosis should be recorded, even if there is no discernable harm to the patient, but I suspect they are in some way shape or form in the patients notes… If a more medically literate person should come along feel free to enlighten me as to the situation with notes…

The figure “15%” is essentially meaningless, some things are fairly easy to diagnose some may be quite diffiult to spot. Medical diagnosis isn’t an exact science much of it relies on subjective expert judgements. There may be a few factors that effect the diagnostic process, in which case the diagnosis is made in a kind enviroment, or they may be made in an unkind enviroment in which case there will be many factors – many of which may be ambigious.

To take the obvious example from popular culture have a wee swatch at House. Yeah the correct diagnosis for this medical Perry Mason is nigh on always correct but the diagnostic process is often a rocky road. Symptoms are not black and white – is that lump in your throat cancerous or a goiter? Many diagnoses rely on patient self report of symptoms – how do we know to what degree these are reported accuratley?

Practitioners judgements will also be affected by prior experience and training. Indeed you might be better off seeking a diagnosis from a relatively new medical doctor then you would from an experienced medical doctor for this very reason. The weight of history will guide the older medics hand more then the younger doctor whose inexperience can result in a more diligent exploration of symptoms to make a more accurrate diagnosis. I suppose you could say that expert judgement, to an extent, suffers from an induction problem bred from familiarity…

There has been highly emotive, as you might expect, footage on the news in Scotland involving deaths that have arisen from people being “misdiagnosed” balanced to be fair with the fact that most diagnoses are correct. But the overall message seeming to be “Doctors aren’t doing their jobs”.

Well in my opinion they are: it’s just their jobs are pretty damn hard in the first place!

(Note: blog subject to change when I have access to my library of clinical decision making literature. As this post is perhaps more ranty then sciency at the minute. Apologies – I will rectify this)