Doctors might not really have a grasp on the art of diagnosis

January of 2010 initiated me into the life of a chronic pain patient. For sixteen months I plunged into a diagnosis journey that brought with it ten misdiagnoses by eleven respected physicians, fifteen procedures and tests, twenty-two medications and crushing pelvic pain.

People have asked me if I am angry about it all; the misdiagnoses, prolonged pain, time spent, needless tests and sometimes painful procedures. Anger is not the presiding feeling, fear is. Fear that doctors are not as skilled with the art of diagnosis as we might think. I do believe that ten out of the eleven physicians I saw tried their best. They were looking for common ailments, not zebras.  But by the time I got to the ninth specialist, fear choked my hope for an accurate diagnosis and treatment plan and accelerated the idea that I might have to live with the pain for the rest of my life. A couple of physicians actually suggested that I adjust to the pain and just live with it. I had things to do, a second book to write, a daughter to take care of. I was not going to give up.

In the end I stumbled upon my own diagnosis in a New York Times article, In Women, Hernias May Be Hidden Agony. As I read about a woman with chronic lower abdominal pain exactly like mine, I raced to the phone to find the surgeon and hernia specialist who had cured her. I found that surgeon all right, and luckily for me she was located at a highly respected teaching hospital in my city. She accurately diagnosed me with a thorough exam and high-resolution dynamic MRI and performed three-hour surgery to repair my inguinal hernia with a nerve passing through the hole and a muscle tear with nerve involvement at my C-section site. I’ve been pain free for over two years. I am immensely grateful to her.

What I’m left with is not so much anger at the physicians who got it wrong and prescribed unnecessary medications and performed unnecessary treatments such as bladder installations and steroid injections into my pelvic nerves, but a deep fear that any physician I see might not diagnose me correctly. Every time I go near a doctor’s office, fear cooks my confidence and I wonder if I will be helped or left to find my own diagnosis, again.

Logically, I understand that the physicians I saw were mostly specialists — they were focused on their specialties, whether gynecology, urology, neurology, and others. And hernias are rare in women. But I can’t get past my knowledge that physicians don’t know absolutely everything, that medicine is not a cookbook. It doesn’t help that I’ve interviewed over 400 physicians, nurses, other medical professionals and patients for my books.

In those interviews, I heard directly from doctors about how they felt about their patients, about practicing medicine and healthcare. While frustration wasn’t at the top of everyone’s list, it was certainly up there.  During my chronic pain condition I didn’t want to be one of those patients who was dismissed or disliked by doctors so I acted accordingly. I did everything I could to support their efforts to arrive at an accurate diagnosis and treatment plan, including coming prepared to office visits with pertinent medical records, symptom diary, my list of questions, top three medical concerns, list of medications, and more. I was prepared, professional and polite. I was determined not to be seen as a “difficult patient” or allow any of them to think the pain was all in my head.

Whether it was the lack of time in office visits, focus on specialty or simply a lack of knowledge about hernias in women, I came away from that 16 month diagnosis journey profoundly afraid that doctors might not really have a grasp on the art of diagnosis unless the diagnosis is fairly common and they’ve treated it before.

Misdiagnosis is common. According to the Society to Improve Diagnosis in Medicine, diagnostic errors occur in 10 to 15 percent of cases, leading to an estimated 40,000-80,000 deaths annually in the United States.

How do I know if a doctor in my future will get it right? I don’t.

Martine Ehrenclou is a patient advocate and speaker.  She is the author of Critical Conditions: The Essential Hospital Guide to Get Your Loved One Out Alive and The Take-Charge Patient.

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  • NewMexicoRam

    Sorry you had to suffer for so long, but this is another story of someone looking for perfection.
    Seriously.
    Mistakes will be made in every area of life. Look at our current president, but he’s still our president.
    Go on. Be glad you found someone to help. But don’t think that everything in life is going to be 100% correct.

    • DoubtfulGuest

      I actually agree with you. I had a lot of the same feelings as Ms. Ehrenclou before I was correctly diagnosed. But wow, 16 months is on the short end, compared to how long it takes for some people.

    • rbthe4th2

      I disagree. I wasn’t looking for perfection. I was looking for someone who would do 1 round of complete testing, we look at it, formulate a plan from there. That should be true of every doctor: not just partial testing or passing the buck around so things never get tested.

      • DoubtfulGuest

        You’ve been at it for a long time, though, haven’t you? I’m not sure NMR would say the same thing to someone who waited, say, decades for a diagnosis or was treated unkindly by multiple doctors.

        I AM sorry she went through this, despite my partial disagreement with her interpretation.

    • wshayes

      It’s not that a mistake was made. It was more that there were more than 10 mistakes made in a row. The same type of thing happened to me (over 15 months or so) where I was lucky enough to have get a new GP (since my other one was on maternity leave – which might have saved my life – a year with very little sleep had left me in a bad way) who reviewed my case after a neurologist, neuropathic pain specialist, and a couple of other doctors whom I’m now forgetting due to the lack of sleep my condition led to. The neurologist, since he couldn’t figure out what the problem was, assumed it was all in my head (and said so – in the process of referring me to a psychiatrist).

      My new GP at the time, Dr Karkalas in KoP, PA (EXCELLENT Doctor) who spends his nights reviewing his patients’ challenging conditions, figured out that the rib/back pain I was feeling with great clarity was due to referred pain from a nerve in my esophagus being enervated due to acid reflux disease. The symptom of pain coming on after laying down for 2-3 hours to sleep with almost an electric current feel from my spine around a rib to the sternum was completely baffling since it hadn’t been seen before by the other physicians.

      We shouldn’t plan for a system that relies upon brilliance in an unsustainable fashion. Also, we get what we measure – Med School metrics are more focused on excellent memories – best for recognizing patterns already known.

      • DoubtfulGuest

        Re: “assumed it was all in my head”, why am I still surprised that this happens to men, too? Glad you found someone willing to take another look.

        • rbthe4th2

          It hits across every where. Gender is no object, nor is color or the lack thereof in my case. You would figure WASP men would be ok but NOPE we aren’t.

  • Dr. Drake Ramoray

    ================================================

    Misdiagnosis is common. According to the Society to Improve Diagnosis in Medicine, diagnostic errors occur in 10 to 15 percent of cases, leading to an estimated 40,000-80,000 deaths annually in the United States.

    =================================================

    I think the best way to fix this is shorten the duration of training and ask doctors to see more patients. Whose with me?

    Ezekial Emmanuel (one of the prime defenders of the ACA):
    “For internal medicine, pediatrics, and similar 3-year residencies,” his article claims, “the third year is not essential to ensure competent physicians.”

    http://www.kevinmd.com/blog/2012/04/reducing-training-diminish-status-physicians.html

    Insurance companies on the ACA exchanges in many states who state:

    “Insurance officials acknowledge they have reduced rates in some plans, saying they are under enormous pressure to keep premiums affordable. They say physicians will make up for the lower pay by seeing more patients, since the plans tend to have smaller networks of doctors.”

    http://www.kaiserhealthnews.org/stories/2013/november/19/doctor-rates-marketplace-insurance-plans.aspx
    /s

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      …and HMO/ACO/managed care, where you can’t see “eleven respected physicians” just because you want to, and can’t have “fifteen procedures and tests” particularly if they involve high-cost imaging. So whatever the first diagnosis was, it must have been the right one….

      • Dr. Drake Ramoray

        It is a sad state of affairs when this is one of the reasons I will always try and stay in medicine even as it becomes more unbearable. Our healthcare system is moving to a place where the kind of care you get is in part dependent on your connections. Being a doctor opens doors. Its sad, but true.

        • rbthe4th2

          This is why I got asked why don’t you say anything about your education? I said because they treat you differently. Basic health care shouldn’t be only for those with a PCP.

        • Suzi Q 38

          So true.
          VIP treatment is very real.
          So unfair, but life is not fair.

  • southerndoc1

    You’ve identified the problem; what do you recommend as the solution?

    • DoubtfulGuest

      I don’t know a magic solution, but:

      1) It’s not so bad if you don’t know what it is.

      2) Just don’t get mad (at the patient) if you don’t know what it is.

      • southerndoc1

        Maybe team-based health care is the answer, where the patient is not allowed to see one doctor, much less eleven, and is randomly assigned by the high school dropout answering the phone to a physical therapist, social worker, IT specialist, or change facilitator?

        • DoubtfulGuest

          Huh? That sounds…productive. :)

          As I hinted at below, my take on this article was: So, 10 out of 11 doctors tried hard and were nice to you and it ONLY took 16 months?!?!?!? Sign me up, retroactively!

          I didn’t mean my comment personally towards you. I never had a problem with “I don’t know” from doctors. I did ask them to keep trying, periodically. Turns out I have a fairly serious progressive disease. Many mistakes were made with my diagnosis and care…I don’t mind that, either. I mind them getting mad at me when they didn’t know, blaming me for their mistakes and covering up the mistakes. I’m not angry at all at the ones who made honest mistakes and continued to treat me kindly. I’m somewhat sympathetic to Ms. Ehrenclou’s ordeal, but at the same time, it does come off like she expects perfection and is not really grasping the big picture.

          One solution would be more time to talk with the patient…not sure how to get that.

  • azmd

    This is a frightening reality in medicine today; I have experienced it myself, and so has one of my children, who recently diagnosed himself, via the internet, with a very obscure condition (in my specialty) which I had actually never heard of. Perhaps the answer is that it is frequently not going to be possible, given the realities of today’s medical training (superficial) and practice (hurried), for an accurate diagnosis to be made early in the course of a relatively unusual condition.

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      This is actually one area where computers could be helpful. After eliminating all the horses, those Jeopardy type computers who know how many people live in Cote d’Ivoire, could round up all the zebras for you and throw in a few giraffes as well…

      • azmd

        Actually, we already have something like that. Google’s search capabilities are now sophisticated enough to provide a fairly credible list of possible diagnosis if you plug in a series of signs/symptoms.

        The trick is getting doctors to think out of the box far enough to do that in difficult cases or cases where the patient’s symptoms are subtle enough that the doctor does not feel that there is likely to be a real problem.

        Why the practice isn’t more widespread, I don’t know. I personally do it on a fairly regular basis when I am checking myself on something that I don’t feel 100% confident about.

        • DoubtfulGuest

          Do you think it’s a time issue? Do you do this with the patient or between visits? Either way, it’s great and I wish more doctors would make the effort. Seems like in many cases it would save time in the long run.

          • azmd

            I am pretty sure it’s partially a time issue. I do it between visits, but I can do that because I do inpatient work and whatever I find out or conclude can be discussed with the patient when I see them the following day.

            Also, I trained back in the days of the dinosaurs when we were expected to be obsessionally thorough in our pursuit of a diagnosis. I think today’s standards are a little different, partially because there’s been an explosion in the volume of medical knowledge and no one can be expected to keep up with it, also because there are very significant constraints on time that a doctor has to spend on any one given case. So there may be sort of a nihilistic approach that most doctors have to figuring things out these days.

            In my job, which I am lucky to have, I am given the time I need to figure out solutions for the sickest of the sick. Other docs are not so fortunate, as I notice when I go to see my own doctors.

          • rbthe4th2

            I do it to help out my docs. If I can do something credible to save their time, support their diagnoses, I do it!

        • http://onhealthtech.blogspot.com Margalit Gur-Arie

          Yes, Google is good, but one thing you cannot do with Google is to throw in the patient’s medical record, and also Google has no concept of context. The IBM computer could read all the medical literature, plus the chart, and do a contextual search and ranking. It should be far superior to a Google search…. eventually…. :-)

          • azmd

            Well, that’s probably all very true! Assuming someone who actually knows something about medicine gets involved in developing it.

      • ninguem

        Oh, fine, but you still haven’t cured my bad case of HTTP 404.

        So I brought my eight reams of Internet printouts to my doctor and he suggested using the computer to diagnose my prostate.

        Which way should I stick my iPhone?

        Landscape or portrait?

    • rbthe4th2

      What about then testing other areas or deeper within your own area, or (gasp) actually looking for changes and lab values that are high or low normal? This is how I could accurately diagnose my condition. That and I didn’t have the nerve to say that spider veins and dark strong smelling urine was the result of anxiety.

  • Dr. Drake Ramoray

    “First, do no harm.”

    “Second, rule out badness.”

    “When you hear hoofbeats, think horses, not zebras”

    “Believe nothing, trust no-one, document everything.”

    “Never settle for a diagnosis”

    A few ones I’ve picked up along the way.

    Now that last one doesn’t mean you second guess yourself constantly. But don’t take other physician’s diagnoses as truth either, and more importantly if someone doesn’t respond to treatment the way you think they should, then re-evaluate your diagnosis. That patient when you are an intern on the Cardiology service with Carpal Tunnel, Sleep Apnea and repeated admissions for “Ischemic Cadiomyopathy” might just turn out to have Acromegaly :)

    Good luck! :)

    • rbthe4th2

      Thank you for the comment Dr. Drake, about taking other physicians diagnoses as truth and when someone doesn’t respond to treatment, re-evaluate the diagnosis. I’ve had the worst time with this, with doctors simply not being thorough and just parroting what they read in the notes (and not that a patient didn’t respond for 8 months to a treatment). I wish others docs would have passed this along before I’ve had problems – looking like liver disease/damage and a few other things because nothing was discovered or treated.

      • DoubtfulGuest

        If I may add to your comments, R, I have a small issue with Dr. DR’s statement:

        “Believe nothing, trust no-one, document everything.”

        Okay, but also: “Don’t accuse the patient of faking or lying when there’s no evidence of deception”.

        • Dr. Drake Ramoray

          I was not specific enough in that one that, this applies to testing and the opinion of other physicans and not the signs or symptoms from the patient. Never trust a radiology report, always look at the films yourself. In my case if there are studies that you encounter frequently (ultrasound, MRI) then learn to read them yourself. If I get a consult and the clinic note says the labs are “normal” I alway request a hard copy of the labs. “Normal” in a clinic note is not sufficient. If the hard copy labs are normal and the patients signs or symptoms fit abnormal labs then you repeat them.

          I have even repeated labs of my own orderin when I was convinced they weren’t correct. Endo’s need to be very careful with their lab testing.

          “Believe nothing, trust no-one document everything” is related to the handing off of care, provided information from other doctors, and accepting the opinion of other doctors”. Always, always verify for yourself.

          It does not apply to signs or symptoms the patient has expressed but does include when the patient tells me a test is normal and I don’t have a hard copy if the results.

          • DoubtfulGuest

            I see. Having been subject to the other version I like yours much better. Thanks so much for your thoughtful response, and for adding mine to the list.

            Of course doctors must always consider lying and faking. In many instances such as you describe the patient is endangered by deception. The doctors who finally diagnosed me correctly went through all this with the right attitude — with the possibility of my faking down at the very bottom of the list, where it belonged, since there was no evidence whatsoever that I was not honest. It was just a zebra, that’s all. I’m still trying to recover from the shortcut approach taken by earlier doctors. Very kind of you to explain your thought process — thanks!

          • rbthe4th2

            We must have had the same docs. I got attitude from a lot of docs, among other things. I’m sorry its complicated, but didn’t people go into medicine to help all, not just the easy cases?

          • Kristy Sokoloski

            This is why now I made sure to let my PCP that I have now know on a couple of occasions that I do not do things simply so that if he was uncomfortable with caring for me then he has an out. So far he hasn’t taken it. And that’s great. The specialist he just sent me to so that we could further work on trying to make it possible for me to get back to Nursing School was very good. But again I let this doctor know that I do not do things simply and he was ok with that. His answer? Well, that’s why you’re here. I am glad he’s willing to try and help me all that he can.

  • Shirin Towfigh

    I share Martine’s concerns.e as a patient; me as a physician specialist.
    I have a very short list of physicians to whom I refer who are interested in problem-solving. There are very few “Dr House”-types out there. To m patients with unknown diagnoses are just difficult, have psychiatric undertones, are pain-seeking, malingering, or exaggerate their symptoms and if you just ignore them, they’ll go away.

  • Thamar Ortiz

    I have learned that when you are not sure about the diagnosis you have to be honest with your patient and work with her/him to see what is the best for both, it could be more tests or referring the patient to another physician.

  • Gaspere (Gus) Geraci

    Eleven physicians for one problem? May I suggest a solution. Find a good primary care physician who will guide you. My best diagnoses were on patients who baffled me, saw a specialist who struck out and came back to me bewildered, until we found a solution. Moving on to another physician entirely starts you from scratch. Working with a physician who gets to know you, and wants to work with you, not just send you away to another specialist, is the key. One good primary care physician doesn’t have to know THE answer, but they can figure out what the answer is NOT, and help you find the answer before you get to the fourth and fifth physician.

    • rbthe4th2

      Thank you!! That is correct, I’ve gone through several physicians for a problem. I think its very telling that one recommended PCP I had did exactly what you said: gave me a mental diagnosis and then sent me out at every little thing to a specialist. When I chose the specialist, not him, things worked great. When he did it or interfered, life was bad.

      • Kristy Sokoloski

        I am sorry that you have had to be the one to decide on who the specialist was to help take care of you.

        • rbthe4th2

          Thanks. I’m sorry for your troubles also. I think a good deal of the problem was they’d just refer in house or to people they knew. The problem is that people they knew had the same mindset. My problems got fixed or easily diagnosed once I got away from most of the “if I can’t figure it out in 20 min then you must be mental” crowd.
          Maybe you docs can talk to who you refer out to and how you figure out to refer?

          • Kristy Sokoloski

            Thanks. Your comment about having to find your own specialists instead of letting the PCP do it further validates my point of that why some like myself prefer to coordinate our own care. And oh boy do I remember dealing with a few doctors that tried to make the statement “you must be mental” when things then got too difficult. And even though I have a good PCP now who is trying to coordinate my care because of prior experiences (yes, you read that right, because I only gave the one example) I am still concerned (and always will be) about what happens when something goes wrong again because he coordinated the care instead of me. I have a couple of friends that don’t get the reason for why I feel the way I do, but that’s ok. Each to their own.

          • rbthe4th2

            I totally understand and its worked out better for me. I think that is something that the patient should handle also. They need to make the connection to the doc, and while the doc can suggest, the patient is the one who needs to make the effort. Again, anything that lessens the docs’ workload so they can concentrate on diagnosis, etc. I am willing to do.

    • Karen Ronk

      You are so right – it takes one good physician who really cares to help find out what is wrong. My orthopaedic surgeon has actually turned into a primary care doctor of sorts, sending me to other doctors to help find my diagnosis. Sometimes, you have no choice but to move on from a doctor when they refuse to address your symptoms. Your approach sounds much like my current doctor’s method and your patients should consider themselves fortunate.

      • querywoman

        I know that my current endocrinologist has new treatments that he used to me. But, I think if I could have had him twenty years ago, he could have really helped me. Our relationship is so very, very good!

        • Kristy Sokoloski

          Querywoman,
          I am so glad to hear that you have such a good relationship with your endocrinologist. Finding a good doctor to have a good relationship with regardless of the specialty can be very challenging for some people. May your relationship with him last for many more years.

          • querywoman

            Thank you, Kristy. It’s nice to have a civil exchange on kevinmd.

          • Kristy Sokoloski

            I agree, especially when there are so many hotly debated topics that come up.

    • Kristy Sokoloski

      I have met some who had a Primary Care Physician that was supposed to try and help them through the process of getting a diagnosis when it came to the various specialists that were recommended to be seen and the diagnosis still wasn’t made. In my case for one of my problems before it got diagnosed many years ago Primary Care kept wanting to send me to one specialist that I knew would not help figure out what the problem was. And to get the diagnosis of that particular problem it took me almost a year to find out what it was.
      We don’t know that the author didn’t have a good Primary Care Physician but to hear this kind of story of having to go through multiple doctors in to the big numbers like that is not something unheard of. There was a program that used to run on one of the cable networks that talked about cases like this where it took a long time to get a diagnosis. Didn’t matter whether the diagnosis was rare or common.

  • buzzkillerjsmith

    Hernias in women can be hard to dx, but 10 docs is a bit much. Would having a concierge doc, one who could have seen you over and over and ridden shotgun as you went from one specialist to another, one who could actually think a while about your case, have made a difference? IDK but something to consider.

    Our coming medical system will be focused on processing people with chronic illness. Dx of unusual illnesses does not save much money–might even cost more. Suboptimal but there it is.

    • DoubtfulGuest

      Change of doctors can be multifactorial…I saw 31 before I was diagnosed, but that was over about 7 years. My disease actually requires treatment by a team of specialists. My total includes the ones who are taking care of me now. Some others fixed related problems that are now resolved so I don’t need to go back. Some of these doctors I went to only because of a long, drawn-out game of hot potato, with me as the potato. I also had, let’s see…4 of those doctors terminate me because they assumed I was malingering. Oops.

      I see your point, though. If we’re looking at a total of 16 months, how is that even long enough to determine whether or not some of the treatments worked? That is an average of ~ 1.45 months per doctor…were none of them given a chance to think about it more or try some alternatives?

      • rbthe4th2

        Wow! Doubtful you just stated almost word for word what happened to me (except change the numbers). I think several of the docs hit it on the head, especially buzzkillersmith. Sad to say … but I’m also an advocate for myself and I present medical peer reviewed literature, so I scare docs. I’m here to help gang, to ask questions and get out of your offices, not to sue you. I want to participate and I want to help, and I actually do the research so YOU don’t have to and can spend your time doing other things.
        I feel like stating that on my records. It shouldn’t be a crime.

    • querywoman

      A good general doc, an FP or an internist, should already be functioning as what you seem to think a concierge doctor should be.
      I have not seen many who do. When Kaiser was in Texas, they certainly didn’t do it for me.

      • fatherhash

        i think what buzzkiller is talking about in terms of concierge doctor is NOT something a “good general doc” in the current insurance system could be. he referred to a type of doc that could have “ridden shotgun” which i assume to mean actually coming to specialist visits with the pt. also, the current fee-for-service insurance system doesn’t seem to allow the time/pt that concierge medicine allows.

  • Suzi Q 38

    What makes me laugh are all those radio, TV, and billboard ads that try to get you to their hospital because they have the best teams of doctors and medical professionals.

    In my case, the specialists are not on any “team,” trying to figure out what was wrong. They filed my concerns and complaints under “hysterical female” and called it a day.

    They didn’t talk to each other or try to get a meeting with another specialist to try to figure it out.

    They just let me flounder and decline….when things went really tough, my doctor didn’t answer my emails and promptly went on a European vacation. He didn’t even tell me what to do since he was going on vacation.

    I was on my own.

    I am less trusting now, and have a lot of questions when I see a doctor.

    I no longer trust all doctors like I used to.

    • querywoman

      There are many of us “hysterical females” around. I got this when I had very serious premenstrual syndrome and bled for 15 days a month for 24 cycles.
      My ear tubes collapsed with swelling premenstrually, and I had agonizing premenstrual neck spasms from swelling.
      But my “personality disorder” was more important.
      And none of these doctors talked to each other!
      As I go on and on about ad nauseum, what I got was a blood pressure cuff at every turn. Is this all the average medical doctor is trained to do? And then cholesterol testing when that became popular. And recommendations for mammograms!
      In your case, your hysterectomy should have cured you of your main problem, having female reproductive organs. And then when you had problems, you were a whiny woman.
      If you read Nora Coffey’s site, you will find that many woman have had to go to other doctors after hysterectomies because their surgeons were through with them!

  • Kristy Sokoloski

    Becky,
    Sorry that you have had such a hard time with doctors. I just had to have surgery for my 5th toe on my left foot on Friday and it was done by my Podiatrist. My foot problems are caused by the fact that I have mild CP. I am glad that your physiatrist is so helpful.

  • Kristy Sokoloski

    Thanks Becky, I appreciate it.

  • rbthe4th2

    OH MY that is the BEST idea I’ve heard in ages! They could continue their education and be a link between what docs say is crappy EHR’s and have a first hand account doing it. Or have these students work with IT people who are business and not medical people. Best of both worlds!

  • http://www.myheartsisters.org/ Carolyn Thomas

    Thank you Martine for this. I’ve been writing about misdiagnoses since being misdiagnosed myself with acid reflux despite presenting in the ER with textbook heart attack symptoms (central chest pain, nausea, sweating, pain radiating down my left arm). But I learned later (after finally being admitted to hospital with a diagnosis of “significant heart disease”) that my misdiagnosis experience was tragically not unusual, particularly for women in their 50s and younger. A study reported in the NEJM, for example, found that women heart patients are seven times more likely to be misdiagnosed and sent home from the ER compared to our male counterparts (Pope et al, Missed Diagnoses of Acute Cardiac Ischemia in the Emergency Department. N Engl J Med. 2000;342:1163-1170)

    We know that Emergency personnel are still sending home women suffering cardiac events, misdiagnosed with indigestion, anxiety, stress, or menopause (a great all-purpose misdiagnosis). One of my readers told me that she’d returned repeatedly to the E.R. because of alarming heart attack symptoms, but was sent home each time with a variety of misdiagnoses. On the third visit, she was told to consider taking anti-depressants. On her fourth visit, she underwent double bypass surgery.

    Mayo Clinic’s Dr. Mary O’Connor blames incidents like this on what she terms medicine’s “unconscious bias” against women. More on her work at: http://myheartsisters.org/2013/08/27/unconscious-bias/

  • guest

    Because they have not actually practiced medicine at all and so would be about one-half notch above your typical medical software developer who knows nothing about medical workflows.

  • querywoman

    I think that hospitals as well as doctors like the income of routine hysterectomies and c-sections.
    What does one expect a knife-happy doctor to say? It’s sooo necessary and has few side effects.
    You mentioned Nora Coffey, and that’s where I think Suzi Q will find much emotional support.

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