Most Americans will get a wrong or late diagnosis at least once in their lives

What is frustrating is cases where doctors insist they are right, and how dare you the patient question their expertise based on your internet research.

I mean, look, I totally get their side--you are paying them for their knowledge which they accumulated from years of practicing and years of specialized training. You SHOULD largely trust them. But doctors are also often overworked, and may not always specialize in your particular area. You also obviously have a much more vested interest in the outcome as a patient, so there's a decent chance you'll spend much more time researching it than your doctor.

All of this to ask..."how can we strike a balance?" If one has doubts about what their doctor is telling them, they can always get another opinion. I just wish there was a better way to vet any research one might do on their own without the doctor getting upset that you continued to look into the matter instead of just taking their word on it when things don't improve.

Personally, I have an awesome doctor, but when I have these concerns I preface them by saying "I recognize this is internet research, and I trust your opinions on these things, but I had X, Y and Z questions." They have always been perfectly happy to answer my questions and address my concerns (as I would hope given what they bill my insurance for a 15 minute visit...)

As someone currently dealing with two completely seperate but overlapping medical conditions that have somewhat similar symptoms I'm in a four way battle between what I think, what my GP thinks and what specialist #1 and specialist #2 think.

Specialist #1 sent me to Specialist #2 who pretty much dismissed out of hand that the problems where related to his specialism but said he'd do the tests anyway, turns out I do have something that is under his specialism.

It's a bit frustrating tbh, the only doctor who's been awesome was the A&E consultant who basically said "this is not normal, march into your GP's and demand the following tests" had he not done that and I not followed his advice I'd still not know what was causing a significant part of the problems I was having nor that certain daily routine tasks could make things horrifically worse.

Isn't this normal, expected and sort of by design for any non-trivial diagnosis?

https://en.wikipedia.org/wiki/Differential_diagnosis

Doctors know they are wrong all the time, but they must keep the cost of testing to a minimum while considering the more life-threatening possibilites first.

I will never fully forgive the nurse who informed me in 1998 that I had AIDS and that I needed set up a living will and get my affairs in order before I began experiencing "cognitive decline." It turned out I didn't have AIDS but a highly treatable parasitic infection from time spent working in the Amazon.

A lot of what Google is doing in life sciences has to do with pursuing earlier, more data-driven diagnostics (eg, http://www.wsj.com/articles/google-designing-nanoparticles-t...).

I'm sure future humans will be horrified to learn that we walked around with barely no meaningful monitoring on our body stats for our whole lives... Only seeking out help when problems got big enough to be visible to the naked eye or bad enough to impair us.

Bodies are pretty complex systems to diagnose. We ask programmers to work in pairs to reduce mistakes and then trust our lives to a single opinion. Buyer beware if you're not getting second opinions.

When you see how little time physicians spend with patients, this is not a surprise. Additionally, new research is continually coming out, and the doctors are often not up-to-date on it. This is a huge problem called Translational Research. For this reason, it is important that you do your own research.

How many of the people here react positively when members of their family share their "internet computer experience" when trying to fix a computer? Yeah, thought so.

Now, let's move on to the fact that the patient is saying "fix me" while the doctor is operating on "First, do no harm."

Now, translate that to some individual who is actively having a health problem that may be dangerous. But who doesn't want to hear things like "stop smoking", "stop drinking" and "get exercise" and wants a pill.

Now, add in people actively trying to scam you to get prescription medication.

Now, some people simply want to be told completely what to do because they don't have the capacity to make the decisions for themselves (cancer diagnoses in particular bring this out).

Finally, doctors are human and are sometimes having a bad day.

etc.

Dealing with people sucks and is an art rather than a science.

My experience with doctors has been this: if the doctor won't explain his reasoning or it isn't logical, I'm getting another doctor. This cleans out the idiots and the assholes.

The flips side is that if the doctor IS explaining something to you: shut the fuck up and listen. The quickest way to leap up the communication scale is to be so informed about what's happening that you can ask intelligent questions about the situation after an explanation.

Just remember, doctors are running with the probabilities.

A well-informed, logical patient is almost as improbable as an Ebola diagnosis.

False positives and false negatives are no fun. I presented with rather obvious signs of colon cancer, but due to my age and lack of family history, my GP misdiagnosed it as irritated hemorrhoids. A year later, I went back to him and he decided he better refer me to a specialist who diagnosed me with a 6cm tumor. Luckily that thoracic surgeon was pretty damn good at his job, and I'm here 10 years later to write this post.

Sometimes medicine is an easy diagnosis, sometimes outliers bite you in the ass...

If you find this article interesting you might consider the book "How Doctors Think". It's basically an entire book dedicated to the subject of misdiagnosis and how our modern medical system has some systematic flaws that contribute to it. If I think about just how often I'm incorrect in trying to diagnose an electronics or software problem, and how little time an average doctor spends on a problem, it's not surprising to me that anything that is remotely outside the norm could be easily misdiagnosed. For me the takeaway is to just accept that for common problems doctors can do a great job, but if you have a condition that is not making progress despite seeing a doctor be open to the fact their diagnosis could be incorrect. I had a minor problem with my ears a few months ago, went to a doctor, was given a diagnosis and treatment which temporarily improved the condition but did not seem to eliminate it. Went to another doctor a few weeks ago, given a different diagnosis and treatment. There you go.

https://en.wikipedia.org/wiki/How_Doctors_Think

This story is a textbook example of bad reporting.

The headline and opening paragraph combine two completely different categories of error--"wrong" and "late"--so that it is possible to say "most Americans".

The story then goes on to talk exclusively about "wrong" as if that was the dominant category. "Late" is never mentioned.

The abstract of the ($60) report talks about errors only, but reading between the lines "late" is subsumed under the author's notion of "error".

So this story tells us nothing about the actual rate of misdiagnosis, but it leaves unwary readers with the probably false impression that "most Americans will experience misdiagnosis".

This is not to say that misdiagnosis is not a serious problem. But then, so is really bad reporting.

I got an asthma inhaler from my family doctor for what turned out to be a collapsed lung, many years ago.

My TLDR: There may be unknown unknowns in the medical system.

It doesn't say how many, it doesn't say the consequences, it just says "most". And since people die, there's probably something we don't know.

That said, I'm not sure this problem as described is one that is even conceivably fixable at this scale. As in, I'm literally not sure that a machine that perfectly diagnoses all the health conditions of a person going forward is logically consistent.

Paul Graham discussed this in the Ongoing Diagnosis section of his Frighteningly Ambitious Startup Ideas article at:

http://www.paulgraham.com/ambitious.html

Its Occams Razor. There's never any point in a diagnosis other than the most common problem that shares your symptoms. Nobody is doing much to weigh the risks of false positive/negative vs each diagnosis' life-threatening properties. Even if they did, they'd have to measure life in dollars (the cost of tests etc) which is a losing game no matter how you play.

In my totally unauthoritative opinion the diagnostic process has been optimized to find the most likely cause as quickly as possible. This isn't a terrible strategy on the aggregate. It increase the overall likelihood that the most people will get the right diagnosis. But the trade-off is that some people will get the wrong diagnosis. The alternative would be for doctors to spend more time really digging into symptoms and tests to ensure they get it right the first time, every time, but then fewer people would get diagnosed.

This would be okay if doctors would accept the limitations of the system and admit when they don't know the correct diagnosis or are not sure. In that case they would say something like "This is the most likely diagnosis, but it doesn't meet your symptoms, you should seek a specialist" or something to that effect. I think what happens too often is that doctors confuse the most likely diagnosis with the correct diagnosis, possibly because they're unwilling to admit their fallibility.

This is an area, that currently available IT technologies could be of great help - if they were seriously deployed:

First, automated medical questionnaires before the visit can gather much more detailed information that a doctor in such a short visit, and display it to the doc in an efficient manner, while letting the doctor verify or ask more. There's a company doing this via tablets at clinics, forgot the name.

Second, medical expert systems(like Isabel healthcare) that could manage the extreme complexity of Healthcare, request missing data, offer an accurate list of possible diagnoses with probabilities without forgetting rare diseases. Basically Dr. House in a box.

But, I fully expect doctors to resist those systems, like in the past, because it takes away from their skill and makes their work boring.

But maybe we as consumers should demand this, both through the political process and through our consumer power?

Doctors "practice" medicine. Know one knows it in and out.

Remember that next time you get a diagnosis. "Doctors practice medicine."

Oh, us poor Americans!

Something tells me this wouldn't be a headline if you replaced "Americans" with "Mexicans" or "Norwegians".