How many people expect perfect outcomes in medical practice?

Want more evidence about how many people expect perfect outcomes in medical practice?

Look no further than the Wall Street Journal: “What if the Doctor is Wrong?” by Laura Landro.

As a substantive basis for the conclusion that initial treating physicians are “wrong” when they haven’t yet reached a diagnosis, Ms. Landro interviewed two patients who, in the midst of a workup, left the doctor who was trying to diagnose and treat their problems.

Said patients then went to a “mecca” to have their workup completed where, amazingly, the problem is “discovered” and “properly” treated. Even though the initial provider in all likelihood would have done the same testing that the “mecca” performed after reviewing the results of the initial testing – had the patient stuck around long enough to have the testing performed. Even though the “standard of care” may have been to do things exactly the way that the initial provider was doing them. Nope, they’re wrong because they didn’t get to the answer sooner.

When reading about all these “errors” I couldn’t help wondering: Did Ms. Landro have a neutral physician review the patients’ medical records to see whether the care provided to the patients was appropriate? Did Ms. Landro interview the initial treating physicians to determine what the next step in their treatment plans would have been? If so, she kind of left those points out of her article.

I understand the idea that second opinions can be useful and I agree that misdiagnoses are sometimes made. Until we find a single test that is 100% sensitive and 100% specific for diseases such as cancer or complaints such as abdominal pain, there will always be misdiagnoses made. Even once a diagnosis has been made, there are disagreements about how to proceed with treatment. Some prefer one medication for treating certain types of cancer, some prefer another medication. Does that make one side “wrong” and the other side “right”? Hardly.

The title of this article and the slant of this reporting make it appear as if doctors are “wrong” just because they don’t make a diagnosis after the first round of testing. Did Ms. Landro even explore how often the “meccas” get their diagnosis “wrong” on the first visit? Are the “meccas” that much better?

If patients want to mortgage their house to get the tens or hundreds of thousands of dollars necessary for a “down payment” at MD Anderson or some other “mecca” when they likely would have gotten similar testing done had they stuck with their initial providers, that’s free market medicine at work.

When journalists imply that excluding diseases on a list of differential diagnoses in the midst of a workup or coming up with “inconclusive” results during testing is “wrong,” shouldn’t we start looking into journalistic malpractice?

“WhiteCoat” is an emergency physician who blogs at WhiteCoat’s Call Room at Emergency Physicians Monthly.

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  • Anonymous

    Article reads like an infomercial for MD Anderson.

    • Anonymous

      Yes, this is what worries me.  I didn’t see anything disclosed about financial relationships (whatever that would mean anyway), but it sure makes me wonder where the line between ad and investigative journalism is. 

      I always thought these pathology and imaging referral services were most often geared toward physicians wanting another, possibly more specialized, opinion, whether or not insurance-directed.  Not to say that a patient couldn’t themselves seek such a second opinion, just interesting that such services are being “advertised” directly to patients, who might have to travel a significant distance to seek care, rather than just have slides or images remotely reviewed with communication via the primary treating provider.

    • http://nonmaleficence.wordpress.com Nonmaleficence

      Agreed. The article was written by an author with the intent to hype MD Anderson. It’s sad that the author is degrading the relationships between patients and physicians across the nation in order to make a dollar. I can’t believe this was published.

  • Anonymous

    This is an article about second opinions and wrong diagnosis.  Do you think that patients should be happy with the wrong treatment?

    “Ms. Harwell says she was grateful that MD Anderson didn’t begin treating her with what might have been the wrong regimen.”

    Wow.  Bashing patients for having the expectation that they will get the right treatment.

    • Anonymous

      Ms. Harwell had no diagnosis when she left the first group of docs.

      MD Anderson thought she had lymphoma, but didn’t know what type and how to treat it, until they did the surgical biopsy. That’s what “wrong regimen” refers to.

      No one gave this patient a wrong diagnosis. Nice try at doctor bashing, though.

      • Anonymous

        So you defend this attitude that patients shouldn’t seek a second opinion?

        So you think Ms Harwell should have had a hysterectomy instead of seeking a second opinion?  You think she was just another stupid patient with unrealistic expectations?

        • Anonymous

          Read the original post, the WSJ article, and my reply:

          No one recommended Ms. Harwell have a hysterectomy.

          She was never given a wrong diagnosis

          I said nothing indicating patients should not get second opinions.

          I never called her “another stupid patient with unrealistic expectations.” 

          Your comprehension skills are apparently quite poor.

          • http://twitter.com/VanessaObRN VanessaObRN

            Per the WSJ article, a gyn-onc at MD Anderson did recommend a hysterectomy, which was peformed.
            “Ms. Harwell says gynecologic oncologist Kathleen Schmeler told her the surgery needed to be a hysterectomy, which would also be the treatment for ovarian cancer on the chance that was the problem. Seven days later, pathology reports from the procedure came back: follicular lymphoma, a rare form of the disease…”

          • Anonymous

            Correct, the hysterectomy was recommended after the second opinion. I changed my post to indicate that.

            In my practice, I always recommend that patients get a second opinion before major surgery like this.

            My point is that, as the story is presended, this patient never received a wrong diagnosis.

          • http://twitter.com/dalecoymd Dale Coy

            If the balancing rewards for practicing medicine keep diminishing, we’re going to be seeing a lot more bad doctors practicing medicine in the future.  

        • http://twitter.com/dalecoymd Dale Coy

          Second opinions are always welcomed when the original MD remains in the loop.  We do care.  IN the case needing a second opinion we either learn something, or the patient finds out the local doc was on the ball.  When there is blame, nobody wins.

  • http://www.facebook.com/people/Debbie-Thompson/100000225773725 Debbie Thompson

    I went doctor to doctor for over 20 years, trying to find out what was wrong with me, and what I heard was, “it’s in your head”, “allergies”, “you’re just pill seeking”, etc. I must’ve seen at least 70 different doctors, during all those years. Finally, near death in 2007, I found the doctor who saved my life. Rocky Mountain Spotted Fever and Typhus were diagnosed, and I was told that I’d had it for a really long time. Lyme was discovered, 2 years later, after a brain MRI (ER visit) found a dozen lesions. I consider “in your head” to be quite abusive, don’t you? This has ruined my life, and the lives of my children (born with it). 

    • Anonymous

      technically, lesions found on brain MRI are “in your head.”

      sorry… couldn’t help myself

    • Anonymous

       your children were born with Lyme disease?  and you had RMSF for “years?”  I’m sorry for all of your illnesses, but was “doctor” actually diagnosed these non-chronic conditions?

  • Anonymous

    Your auto mechanic usually offers a one year warranty on parts and labor, right?

    • Anonymous

      So what?

      My lawyer, accountant, financial advisor, and priest don’t offer one year warranties.

      Get your health care at Jiffy Lube if that would make you happy.

      • Anonymous

        Jiffy Lube? Sounds like a good idea. How much worse could it be than what we have now? Fact is, my “Jiffy Lube Health Care Provider” will soon be a huge 7 hospital ACO group that has been rapidly organizing since last summer. They’ve been buying up small practices all over the region. My PCP has already signed a contract to move his patient base over as soon as they open their doors. He’ll become a salaried employee. It’ll be the Home Depot of health care in our tri-state region. They will do what WalMart did for retain sales. Good luck. I hope all of the Marcus Welby types survive the competition. It will be fierce!

      • Anonymous

        Don’t feed the troll.

        • Anonymous

          Ah, mission accomplished! Returning to base!

  • ellendastork

    I have had very negative interactions with “mecca” Drs. After dealing with a MRSA infection in my left hand after surgery for a torn ligament for nearly 6 months, I went to see a “super-specialist” at Mass General, to be told that I needed to work with a psychologist because my Drs. at home had over-reacted, because I  was overly concerned about the infection! I can’t imagine why a surgeon would worry about her hand. Amazingly, he did all this “diagnostic work without even reviewing my records! Meccas are NOT always the best place to receive care

  • Anonymous

    I am sure you agree that to err is human.  To err dissociates any human activity including the exercise of medical applications from perfection.  According to your opinion, if there is a perfect doctor, can you please identify the characteristics of a perfect patient.  What is your opinion of physicians who are late to their appointments with their patients and distribute money to them for their delay.  Doesn’t that reflect how physicians assign monetary value to time.