Articles Posted in Failure to Diagnose

One of the clinical paradoxes facing doctors is determining when to use antibiotics to treat bacterial infections. The difficulty arises because some viral infections are indistinguishable from bacterial ones. When a doctor chooses to prescribe an antibiotic out of sheer caution, it could result in the creation of antibiotic resistant superbugs. The failure to use them could put patients at risk of infections, which could result in hospitalizations and increased healthcare costs.

Despite these difficulties, there are innovations coming that could help doctors in making informed decisions about how to treat patients. According to a medicalnewstoday.com report, a company has announced the results of clinical testing of a diagnostic blood test that would enable doctors to tell the difference between a bacterial and a viral infection. 

The test deviates from common pathogen detection by relying on the body’s immune response to determine the cause of the infection. Essentially, there are three distinctive proteins are activated by viruses and bacteria. The test incorporates an algorithm that when integrated, can create a unique signature that helps doctors understand what the accurate cause would be.

We have written before on the concept of defensive medicine and the monetary effect that it has on health care costs. Essentially, many doctors have become used to performing unnecessary tests to rule out potential conditions out of fear of being sued for malpractice down the road. This practice has been chronicled as one of the reasons for the dramatic and continuing increase in care costs.

However, in a number of states where medical malpractice reform has changed the standard in which patients must prove harm, it appears that doctors are still hedging their bets and relying on additional tests even when they are not required. 

According to a study conducted by research non-profit RAND Corporation, defensive medicine is still the norm despite changes in the law that basically grant immunity for some doctors; particularly emergency room physicians. The study compared data from Medicare patients from Georgia, Texas and South Carolina (three states that enacted malpractice reforms) and compared them to states that did not pass such reforms regarding quality of care (i.e. whether a physician ordered a CT scan or MRI, hospital readmissions, and total costs of hospital visits).

It is tough enough going to an emergency room after a serious injury, you shouldn’t have to wait an eternity in order to get medical attention. Unfortunately, patients can fall through the cracks in the midst of a busy trauma center, and may not be seen in a reasonable amount of time. When this happens, what may be a commonly treatable injury may progress into something worse and life threatening.

Such was the case of a patient who came to an emergency room complaining of a severe headache and excessive vomiting. The patient’s wife even informed medical personnel that he had recently been hospitalized for bacterial meningitis. He also had been diagnosed previously with deep vein thrombosis (DVT) and had been placed on blood thinners. 

For more than four hours the patient was not seen by a physician despite abnormal vital signs and laboratory readings. Soon afterwards, the patient fell into a coma. Indeed, the patient did not pass away, but a medical malpractice suit was initiated due to the failure to diagnose him in time to prevent a common ailment from progressing into something substantially worse.

While we have written a number of posts on injuries suffered through auto accidents, it is also important to realize that head injuries (particularly concussions) can be suffered through a number of ways. In fact, more than two million people will suffer head injuries severe enough to send them to the hospital  this year.

Traumatic brain injuries can be suffered through car accidents (i.e. heads hitting dashboards or windows), through sports injuries (particularly football and cheerleading accidents), and most notably, falls. Given the icy conditions that we live in, falls on slippery surfaces are common this time of year. 

However, being able to properly diagnose brain injuries is of particular importance.  Besides traditional bumps and bruises, it may be difficult to ascertain whether a person has suffered such an injury because of the subtle ways it may manifest itself. As we have mentioned in previous posts, not all people react the same way to head trauma. Some may have irregular sleep patterns, others may have intermittent headaches and others may have significant mood changes.

A common tenet in the pursuit of curing and preventing cancer is that you have to go to the doctor regularly. This message is regularly directed at men over the age of 30 and younger than 55, because this is the age group that is less likely to see a physician. With prostate cancer being one of the most prominent killers of men, prostate cancer screening is very common for men of a “certain age.” However, a new study suggests that not every man actually needs the screening.

A recent study published by the Canadian Task Force on Preventative Health Care suggests that screenings using a prostate-specific antigen (PSA) may not be the best way to check for cancer. The study indicated that between 11.3 and 19.8 percent of men tested through PSA would receive a false-positive diagnosis. Essentially, the test results would indicate that cancer would be present, when it is actually not.

Researchers were concerned that 40 to 56 percent of those screened would be subject to over-diagnosis, which could lead to unnecessary invasive treatment.

The link between concussions suffered while playing professional football and permanent brain injury has grown over the past few years as more football players are diagnosed with depression, anxiety and other terminal illnesses. The growing number of players exhibiting erratic (and sometimes violent) behavior off the field and even committing suicide has led to rules changes and increased monitoring of concussions on the professional and collegiate levels.

But what about high school football? Concussion protocols have become increasingly important because of new information suggesting that young people can exhibit emotional changes even though they have not technically suffered a concussion. A study presented at the Radiological Society of North America found that small, continuous blows to the head could cause changes to the brains of young football player, even though they have not been clinically diagnosed with a concussion.

Even though the study did not examine how the changes affected brain functions, it brings about concerns as to whether a player should be examined by a brain specialist prior to resuming contact activities. It may also raise questions as to whether doctors are following proper protocols when diagnosing football players.

A number of our posts focus on the legal duty that physicians, nurses and hospital staff in using reasonable care in treating patients. A large part of that duty involves properly assessing patients for treatments; which may include asking questions about what drugs a patient may be allergic to and what their prior medical history involves.

A recent medicalnewstoday.com story exemplifies the importance of these screenings. According to a recent study featured on the site, certain prostate cancer treatments could lead to increased risk of death from heart-related causes. Specifically, men with prior cardiac histories or a diagnosis of congestive heart failure were found to be at risk when undergoing androgen deprivation therapy (ADT).

ADT focuses on reducing levels of male hormones in the body so that cancer cells will not be stimulated, thus preventing further growth of cancerous cells. Despite the success of this treatment, patients have seen an increased risk of diabetes, heart disease and even heart attacks.

A patient who showed up at a Dallas area hospital complaining of fever and headache and was misdiagnosed as a potential Ebola case has passed away. However, in the wake of the man’s death, the hospital is still under fire for missing the diagnosis. According to a fiercehealthcare.com report, the man was initially diagnosed with a low-grade viral infection and was sent home with an antibiotic, despite claims from his sister that he told hospital workers that he had just come back from Liberia.

It appears that a critical piece of information was not shared with healthcare workers, who (in hindsight) should have isolated him to prevent a further outbreak. It is reported that the man may have come into contact with nearly 80 people. 

In the meantime, the Centers for Disease Control and Prevention had sent hospitals a special checklist to prepare for potential Ebola cases. Indeed, hospitals are on the lookout for additional cases. Some are even asking every patient coming to an emergency room or for a scheduled appointment about recent travel overseas.

Diagnosing intellectual and developmental disabilities continues to change as technological and scientific advances are made. With these advancements, the guidelines surrounding assessment must also be adjusted. A recent article on disabilityscoop.com highlights the potential changes that may come about as a result of a clinical report published by the American Academy of Pediatrics.

Specifically, advances in genetic testing have enabled doctors to obtain a better diagnosis of children with delays. For instance, in cases where a delay has been identified in a child but the cause is not determined, doctors are encouraged to work with a geneticist to conduct chromosomal microarray testing that may detect genetic abnormalities that could reveal the actual cause of the delay.

The American Academy of Pediatrics believes that it is important to indentify the root cause of a particular delay so that an appropriate treatment plan may be developed. This also helps families in managing expectations as the child grows up.

For anyone in Oneida who has wondered how doctors can tell if a patient has diabetes, the easiest way is to test the patient’s A1C levels. By ordering a simple test, doctors can learn a patient’s blood sugar levels for the past two to three months. If it is that easy, why are there an estimated 7 million people in the country whose diabetes is undiagnosed?

What is even more frightening is that undiagnosed diabetes has been linked to heart attacks. Roughly one in 10 people who have had heart attacks have undiagnosed diabetes, Had these individuals known of their diabetes and taken the steps necessary to regulate their weight, blood sugar and other factors, it is possible that they would have been able to avoid the heart attack altogether.

Not only does a failure to diagnose diabetes put a patient at risk of a heart attack, but it also dictates how likely a person is to seek diabetes treatment. Since untreated diabetes could lead to a subsequent heart attack, heart disease and a host of medical conditions, it is important that doctors do what they can to get their patients into diabetic treatment.