Misdiagnosis

carachel2 · May 7, 2015

Anyone who says they have not is either a.) fresh out of school or b.)lying!

It happens. Own it. Research has shown consistently shown that providers who own it and have a frank discussion with a patient have better rapport and less litigation. You can have a discussion with the patient that is professional and informational without stumbling all over yourself apologizing.

Jolie, BSN · May 7, 2015

I recently took my daughter to our primary care office for a sick visit. She saw a senior doctor in the practice we'd not met before. He was fascinating to talk to as he explained that he now sees patients for second opinions almost exclusively. He says that he loves the work and believes it makes him "look like a genius" for diagnosing what others have missed. Of course he also admitted that by the time patients see him, their symptoms are more fully developed and he has a record of previous treatments that have or have not worked, so most of the "guess work" is already done.

I think that's a pretty reasonable look at the process of examining, diagnosing and treating patients. It can't always be done in a 10-20 minute visit, nor should we expect it to be.

Jules A, MSN · May 7, 2015

It happens and I would rather know than not, right? The great news about the situation you describe is that it sounds like not only are you contentious and concerned but your Doc was supportive. That is the best of a bad situation, imo. Hang in there and know you are likely to never miss this exact diagnosis again.

cayenne06, MSN, CNM · May 7, 2015

We all make the wrong diagnosis sometimes. It really IS why they call it "practice!" Every mistake is a learning opportunity, a chance to get better at your job. It happens to everyone, even experienced clinicians. If you stay in practice, it will almost inevitably happen to you again, and that's okay :)

Riburn3, BSN, MSN, APRN, NP · May 8, 2015

When you're expected to see patients in 20 minute or less window, you're going to miss a few things. In an outpatient clinical setting, everyone is thinking "horses" not "zebras". If you're like me and you're working in an office without radiology, lab, etc, you're absolutely going to miss a few things or misdiagnose because you don't have the infinite resources of an ER/Hospital. Having spent my whole career before I became an NP in the critical care setting, I really took for granted how nice it is to get information on demand within a few minutes. You have to make due with what you have and just make sure that when you have patients with acute complaints, you rule out the most serious problems, and if you prudently can't, you appropriately refer or send them out.

scottaprn · May 8, 2015

Yep, happens to everyone.

The biggest key I have found is to make sure to have a mechanism to evaluate your intervention for the diagnosis you make. If a normal intervention doesn't help then take a step back and consider everything again.

Psychcns · May 10, 2015

I say to the patient: I did x because of y and expected z and when you are still having symptoms I reviewed everything and want to ask you more questions, would like to order more tests, would like you to try abc. Etc

I usually get it right the first time but when the patient is still symptomatic I assess further.

Medicine is an art based on science.

orangepink, NP · May 13, 2015

we are required to see 20-25 patients per day in a specialty clinic (they even prefer 40-60) and honestly that's pushing it for me. It makes me feel run over and I feel like I'm not establishing patient care very well. One of the reasons this pt was misdiagnosed was he belonged to another provider who left the practice so I sort of inherited this patient. So this particular patient feel into a loophole. When I picked up his case is when I started doing a battery of testing again. So I dread telling him but I know I have to and I appreciate all your input!

Natasha A., CNA, LVN · Nov 22, 2016

12 million people are misdiagnose every year. My question is what are solutions to improve this?

PG2018 · Nov 22, 2016

Probably.

I think most psych patients are or have been misdiagnosed. Our diagnoses are very ambitious and subjective regardless of the DSM. Most clinicians don't read it anyway.

Jules A, MSN · Nov 23, 2016

12 million people are misdiagnose every year. My question is what are solutions to improve this?

A starting point for NPs would include a solid nursing background and an appropriate educational experience taught by skilled clinicians which imo many NP programs are lacking. In psych I also prefer a healthy dose of skepticism because the "good holistic nurses" are willing to buy whatever the patient is selling without using their critical thinking skills hence all the erroneous Adult Onset ADHD and BiPolar diagnoses when it should be ASPD, BPD, trauma hx and/or Substance induced mood disorder.