Saturday, February 25, 2006


In the nested manner of blogging, 3quarksdaily reports on a New York Times article on a JAMA (Journal of the American Medical Association) article*. Chilling: "With all the tools available to modern medicine — the blood tests and M.R.I.'s and endoscopes — you might think that misdiagnosis has become a rare thing. But you would be wrong. Studies of autopsies have shown that doctors seriously misdiagnose fatal illnesses about 20 percent of the time. So millions of patients are being treated for the wrong disease. As shocking as that is, the more astonishing fact may be that the rate has not really changed since the 1930's. "No improvement!" was how an article in the normally exclamation-free Journal of the American Medical Association summarized the situation. This is the richest country in the world — one where one-seventh of the economy is devoted to health care — and yet misdiagnosis is killing thousands of Americans every year. How can this be happening? And how is it not a source of national outrage? A BIG part of the answer is that all of the other medical progress we have made has distracted us from the misdiagnosis crisis." This extract pitches the story as a "national" outrage that thousands of "Americans"(by which I presume the writer means US residents, as opposed to Canadians, Brazilians, Argentinians, etc) are being killed by misdiagnosis every year. I am sure it is not just a US problem, though. Cold comfort indeed. Accuracy of language aside, there is a spirited defence of the medical system in the comments (by an anonymous person): "Comparing the diagnoses of myriads of diseases that afflict the human body with flying a commercial airliner is simply specious: no matter how complex the airliner, it was built by man, with every aspect of its construction, its parts and its operation documented and detailed. By contrast, a physician sees a patient with limited information and a very limited amount of time (no thanks to the health insurance system), and is then expected to deliver near-perfect diagnoses about just what is wrong. Should I add that they are also expected to do this while keeping the admittedly soaring healthcare costs under control? Physicians and surgeons make mistakes because they are overworked, under-resourced, and have limited amounts of time with each patient. But even more importantly, mistakes occur because the myriad human diseases each have myriad presentations, many that are basically (overlapping) non-specific symptoms. Should physicians send every patient who comes in with a splitting headache off for a CT to rule out a brain tumor? " So the situation is that more people are being saved by modern medicine than were saved 100 years ago, but that because medicine is now technical and sophisticated, the definition of "mistake" has become more elastic. See my post below about ability to operate new technology as one gets older and has to forget old knowledge and relearn new, over and over again. Must be hard for doctors to keep up. What "anonymous" is pointing out is that the baseline is much better, even with errors (if they can be called errors when they might be things like not ordering every possible test for every possible condition for every presenting patient) taken into account. * There is no JAMA article. I read the NYT article, after having to register for their site (they require personal info), and found it a string of anecdotes with an unreferenced one-word quote from JAMA somewhere in the middle. No context. No year, even. Low-standard journalism (not to mention zero marks for scholarship).