Author: Heart Pupil
A doctor has told Lilac Garden that "the probability of misdiagnosis will not exceed 10%."
But as a small probability event, misdiagnosis has a journal founded specifically for it. In 1985, the Bethune International Peace Hospital hosted the journal Clinical Misdiagnosis and Mistreatment, which is still being updated nearly 40 years later; in 2001, the Chinese Preventive Medicine Association founded the Chinese Journal of Misdiagnosis; and decades of papers exploring misdiagnosis have also come.
"Small probability", but it matches the journal that has been updated for nearly 40 years. Perhaps it is precisely because there are more problems behind the misdiagnosis that deserve to be investigated.
Misdiagnosis, there is every corner of the clinic
Is there really a small probability of misdiagnosis?
It is reported that "Clinical Misdiagnosis and Mistreatment" has published about 10,000 "misdiagnosed" papers in the past few decades at a rate of more than 20 papers per month. The cornerstone of these papers is the tens of thousands of real cases of misdiagnosis.
Journal of Clinical Misdiagnosis and Mistreatment
Similarly, searching for the word "misdiagnosis" on CNKI, there will be nearly 80,000 articles, almost all of which are misdiagnosed studies of certain diseases, some of which are incurable diseases with a misdiagnosis rate of more than 60%, but there are also non-rare diseases such as myocarditis and pancreatitis.
CNKI searches for screenshots of "misdiagnosis"
Chen Lei (pseudonym), a doctor from the department of endocrinology at a top three hospital in Sichuan, told Lilac Garden, "Dry clinical, misdiagnosis will always exist." "Misdiagnosis" is unavoidable for clinicians.
Zhang Lun (pseudonym), a doctor in the department of thoracic surgery at a third-class hospital in Beijing, gave a more precise feeling, "Almost every day you may encounter a misdiagnosis." For example, patients with the same symptoms may get different answers when they go to two different hospitals.
Compared with the "small probability" of serious error correction, in fact, "deviation diagnosis" appears in every corner of medical treatment.
Liu Zhenhua (pseudonym), an obstetrician-gynecologist at a hospital in East China, once met such a patient: a 65-year-old woman who found a 5-centimeter-sized cyst on her ovary during previous examinations, arranged for her to be removed.
But on the eve of the operation, the woman suddenly had severe abdominal pain, most likely a ruptured cyst, which made Dr. Liu Zhenhua feel like a big enemy - the ruptured cyst was highly suspected to be malignant, and the patient's five-year survival rate was extremely low.
Dr. Liu performed an urgent operation on the patient, and during the operation, it was found that the patient was not an ovarian cyst, but a tubal abscess, accompanied by pelvic inflammatory disease.
Since the patient is 65 years old, Dr. Liu Zhenhua acquiesced that the other party had no sexual life. In fact, the patient's sex life is still very frequent, about 2 times a week, and because of menopause, she and her wife did not use condoms in their sex life, resulting in pelvic inflammatory disease and abdominal pain.
Later, no matter how old the female patient was, Dr. Liu would confirm with the other party that "there was a sex life".
To deal with misdiagnosis, you should look ahead
Fortunately, the elderly female patient was "misdiagnosed", but she was not "misdiagnosed".
Dr. Chen Lei told Lilac Garden that even if there is a misdiagnosis, in most cases there will be no mistreatment. For example, if a patient is initially diagnosed with disease A because of a symptom, but during treatment, the symptoms caused by disease B slowly appear, and the doctor will immediately adjust from the plan against disease A to the treatment of disease B.
Although the initial diagnosis was a misdiagnosis, it did not have much effect on the patient's treatment.
But this is not the result of all misdiagnoses. If a patient is experiencing a condition that deteriorates rapidly, the doctor will not have time to adjust.
In 2012, a medical dispute occurred in Hunan: the patient was a middle-aged man who underwent anterior cervical spine decompression graft bone fixation in a hospital due to cervical spondylosis, and after the operation, acute kidney failure and respiratory arrest occurred, and the hospital gave symptomatic treatment, but the patient died quickly.
The hospital believed that the patient had died of "respiratory and circulatory failure and multi-system organ failure due to spinal edema or laryngeal edema", but the patient's family did not approve of it, and they went to the judicial center and the forensic doctor finally identified the patient as having died of "postoperative cerebral hemorrhage and multi-organ failure".
Later, the deceased took the hospital to court, accusing the hospital of delaying treatment due to misdiagnosis, and the first instance judgment determined that the ratio of fault between doctors and patients was 6:4.
Screenshot of the judgment document network in this case
Such medical disputes are not uncommon.
In the past five years, nearly 10,000 cases have been filed against the judicial organs alone, and there have been countless complaints in the hospital. After a complaint occurs, regulation, compensation, and giving convenience to surgery are often the most common treatment methods at the hospital level.
The sheer volume of complaints has also left hospitals tired, and Dr. Liu Zhenhua said that some hospitals have even put the responsibility entirely on the doctors themselves, asking doctors and patients to confront each other.
Obviously, in most cases, the means of dealing with misdiagnosis becomes "dealing with complaints arising from misdiagnosis".
Image source: Visual China
But in fact, after handling this complaint, there may be a next complaint, which is not a fundamental way to reduce the occurrence of misdiagnosis, but more importantly, what needs to be solved is what happened "before the misdiagnosis".
Dr. Wang Weining (pseudonym) from a specialized hospital in Xi'an told Ding Xiangyuan that he had encountered a case of misdiagnosis of a newborn during training: four days after birth, the baby was found to be congenital atresia, and within four days the child passed through the hands of multiple midwives, doctors and nurses, but no one found it.
Congenital atresia is not completely flat, there will still be a little depression, and the young midwife has not seen the real atresia, plus when examining the anus with a cotton swab, the cotton swab has a little fetal fat, and the midwife mistakenly thinks that there is no problem. The newborn's family was immersed in the joy of the son and did not find it.
This day was Friday, and then the next two days of the weekend were doctors on duty, and the doctors were not many people, and no one found out. Until Monday, the family found that the child had not been defecating, called the doctor for examination, and the doctor found that the child's atresia.
The child was later transferred to a paediatric department for treatment, and midwives were uniformly retrained to ensure that everyone could recognize common neonatal malformations.
This medical dispute exposed the problem of the hospital's internal system: the midwife was not trained enough, and he passed the examination and worked in the absence of ability. Secondly, the shift doctor did not find the child's problem on Sunday even if the child did not defecate all day on Saturday.
Dr. Wang said that in the later practice process, in response to common misdiagnoses, the department will organize interdisciplinary training and invite other directors such as surgery and neonatology to share in the department.
However, these trainings are all invited by the department director point-to-point - the hospital does not have systematic pre-training.
What can a hospital do?
Without the guidance of the hospital's system, some less senior doctors may misdiagnose.
The need for training for young doctors on issues such as "misdiagnosis" is strong, but it is not easy to implement them. Among them, organizing doctors to regularly review difficult cases is a powerful link.
Dr. Zhang Lun's hospital is a top three in Beijing famous for thoracic surgery. Whenever a patient dies, the whole department sits down to discuss the patient's condition and review each node of the change in the condition. Among them, there are many cases of initial misdiagnosis. Dr. Zhang Lun said that after he encountered similar cases, he would pay special attention.
In the hospital where endocrinologist Chen Lei is located, the "Difficult Case Seminar" and the "Three-Level Rounds System" have also helped to reduce misdiagnosis. When faced with a special case, a doctor's judgment is wrong, which belongs to human nature. If more doctors are involved, comprehensive judgment can be more accurate.
According to a Survey by Mayo Clinic, 21 percent of patients seeking a second treatment at the clinic were misdiagnosed at the first visit, and 66 percent were diagnosed more precisely.
Screenshot of the Mayo Clinic website
Many of these difficult cases are binary, not a single disease can be explained, and this is very likely to cause misdiagnosis.
Lin Huijin (pseudonym), an endocrinologist at a hospital in Hainan Province, told Ding Xiangyuan that a young male patient she had admitted to the hospital was a typical ptosis when admitted to the hospital, and had been diagnosed with diabetic neuropathy in the outer hospital, so she gave nutritional nerve treatment, but the effect has not been good.
When she was at a loss, she invited a neurology specialist from the same hospital for consultation, and the expert saw at a glance that the boy was suffering from myasthenia gravis. Later, the patient was transferred to the Neurology Department for hospitalization and recovered well.
Dr. Lin Huijin introduced that such a consultation system has been in their hospital for more than 10 years. "It's a great way to reduce misdiagnosis."
However, although these systems have reduced the rate of misdiagnosis, none of them has been established specifically for misdiagnosis. When Dr. Chen Lei encountered cases of misdiagnosis, he also went to the journal to look up and found that similar cases had long been included in the "Clinical Misdiagnosis and Mistreatment". If targeted training on diseases that are prone to misdiagnosis can be targeted, it is believed that there will be different results.
Obstetrician and gynecologist Liu Zhenhua said, "In the specialist training of some hospitals in Europe, there is a concept of clinical governance, and a series of measures will be taken in each department to reduce the occurrence of adverse events, including misdiagnosis." These initiatives include training, increased manpower, etc. In The structure of these hospitals, in Dr. Liu's view, there is still room for improvement in domestic hospitals.
Dr. Liu mentioned "increasing manpower", and many doctors have made the same demand.
Dr. Chen Lei of the Department of Endocrinology said, "In a morning clinic, sometimes you can see seventy or eighty patients, and the time of each patient really has to be compressed and compressed." At this time, there may be omissions in the doctor's physical examination.
There was a patient with an unexplained fever who came to the doctor's hospital for treatment, and many doctors did not find out the cause of his etiology, and finally found that the patient's perineum was bitten by a bug, causing the infection.
If the doctor had had sufficient time to examine the body in the first place, perhaps this misdiagnosis would not have occurred.
Dr. Chen Lei also mentioned that sometimes the examination equipment of lower-level hospitals is not complete, which can also lead to misdiagnosis. For example, some patients suspected insulinoma after CT in a lower hospital, but could not confirm the location, and the diagnosis was not confirmed until PET/CT was done at her hospital.
Sometimes, excessive punishment by the hospital will make doctors fear misdiagnosis, and doctors who dare not face it will even increase the possibility of mistreatment.
For misdiagnosed studies, it may never end. As Dr. Chen Lei said, "Medicine is broad and profound, and doctors should be like walking on thin ice." In the face of clinical diseases, we will always be primary school students."
Zooming in a little more, solving misdiagnosis is not just a doctor's business. As hospitals and policy makers, we should not stay out of the matter.
After all, reducing the rate of misdiagnosis is closely related to everyone in the industry and every patient who visits the hospital.
Curated by: Carollero
Executive Producer: Gyouza
Title image source: Visual China