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Missed Diagnoses

Posted 1/4/2014

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  Missed or delayed diagnoses can be a huge or a minor problem. If a rash is thought to be one thing and turns out to be another, eventually responding to a topical treatment, it probably does not matter that it lasted a little longer. If a mammogram is read as normal, and then a lump can be palpated a few months later (as happened to me in 1993), it may well not matter in the long run--although it surely raises anxiety and frustration in the short term. If a hip pain is attributed to arthritis or a pulled muscle and turns out to be a first bone met, the statistics tell us that does not matter--that metastatic breast cancer responds just as well to treatment if found a bit later. That one is completely counter-intuitive although all the research supports its' truth.

  There are situations in which it is harder to be sanguine about the delay. The diagnosis of ovarian cancer, always tricky as there is no screening test and the symptoms are usually vague and similar to a hundred other things, may matter a lot. This is a thoughtful and distressing essay from The New York Times by Susan Gubar about this:

Missing a Cancer Diagnosis

By SUSAN GUBAR

Stories of misdiagnoses circulate throughout the testimonies of people contending with all sorts of cancers.
Such errors, made by patients as well as doctors, bring in their wake a sense of betrayal, self-recrimination
and anger. Should we accept them as inevitable?
Like many women, I misinterpreted the muted symptoms of ovarian cancer. Bloating, satiety, fatigue and
constipation are often attributed to menopause, aging, indigestion, irritable bowel syndrome, depression,
laziness or whining. My general practitioner prescribed half a cup of wheat bran, applesauce and prune
juice every day. By the time a CT was ordered a year later, the cancer had progressed to an advanced stage
that is treatable but not curable. I was furious at myself and upset with my doctor.
People leading active lives seem especially prone to dismissing subtle warning signs. The philosopher
Gillian Rose declared, “I was so attuned to regular exercise of body and mind that I could easily take minor
symptoms of ill-health in my stride.” Similarly, the physician and marathon runner Dr. Geoffrey Kurland
deceived himself about symptoms of leukemia: “I now realize that for several months my body had been
giving me warnings I had chosen to ignore, warnings that something was not right with me.”

http://well.blogs.nytimes.com/2014/01/02/missing-a-cancer-diagnosis/?emc=edit_tnt_20140102&tntemail0=y&pagewanted=print



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