why doctors lie?
SHIRL1121
why is it that over 50% of diagnostics and treatments are wrong and in ,any
cases
very dangerous?
Chris Schmelzer
In article <19980104162...@ladder02.news.aol.com>,
shir...@aol.com (SHIRL1121) wrote:
What are you talking about?
--
Chris Schmelzer, M-1
Medical College of Wisconsin
Milwaukee, WI
BrewsterK
shirl1121 wrote:
> why is it that over 50% of diagnostics and treatments are
> wrong and in any cases very dangerous?
Why is it that every bonehead thinks that they know more about medicine than
people who are trained in it. Could you please cite your sources for "50%" and
"very dangerous"?
Brewster
MS1--Arizona College of Osteopathic Medicine
http://members.aol.com/brewsterk/home.html
GuY M
I don't know what the exact numbers are or if they're even available, but not long ago
there was a report saying that 4/5 med students missed common heart problems using a
stethoscope. That's a problem and the news wasn't taken lightly.
The other factor is that most people will stop going to a doctor when their treatment
doesn't alleviate they're pain or physical problems. This come from 2 people that I know
and one of them happens to be my mother. She spent close to 5 years and several doctors
trying to solve her medical problems, finally one doctor diagnosed the problem correctly
and things changed for the better. The second person is an acquaintance and she also was
misdiagnosed, she was even called a hypochondriac by some Drs. Her problem was a
cancerous growth in her intestine.
How do doctors know when they have misdiagnosed a patient? perhaps a good indication is
when patients don't come back.
++++++++++++++++++++++++++++++++++++
BS in ChemistrY, Biochemistry
Minor in Math
AnY quEsTioNS?? ChEck Ur XiX
Spammers will be persecuted.
++++++++++++++++++++++++++++++++++++
Henry Wei
GuY M (s01...@umslvma.nospam.umsl.edu) wrote:
: How do doctors know when they have misdiagnosed a patient? perhaps a
:good indication is when patients don't come back.
differential diagnoses?
chri...@worldnet.att.net
SHIRL1121 wrote:
>
> why is it that over 50% of diagnostics and treatments are wrong and in ,any
> cases
> very dangerous?
Why don't you cite your sources ?? For the record, what the hell do you
know about medicine ??
David Sacco
On Mon, 5 Jan 1998, GuY M wrote:
>
> I don't know what the exact numbers are or if they're even available, but not
>long ago there was a report saying that 4/5 med students missed common
>heart problems using a
> stethoscope.
refer. I didn't read the article, but I was told that the students were
not given a history when they were told to identify the heart problems.
This is unbelievably unfair. Auscultation involves very careful listening
that is directed by the history. It is MUCH easier to identify a problem
when you know what you're listening for. Two sounds that are virtually
identical can indicate very different pathology. The meaning of a sound
is interpreted in light of the history.
> The second person is an acquaintance and she also was
> misdiagnosed, she was even called a hypochondriac by some Drs.
> Her problem was a cancerous growth in her intestine.
Dave Sacco
ms-ii, pitt med
http://www.pitt.edu/~drsst37/applicants
DDNEPTUNE
Shirl
Reason may be that sometimes drs feel that they are being pushed into making a
diagnosis before all the data is in. Truth be told being
in the medical profession is sometimes alot like being a detective
and you can't just jump to a conclusion. Sometimes quick diag-
nosis is a result of family pressure and sometimes a result of an
over zealous dr. As with any profession we are only human and
make human errors just like everyone else.
Joseph T. Ho
I haven't read the report either. However, depending on the year (knowledge
and experience) of the medical student, it is not all that concerning that a
med students missed it (or 4/5 of med students). There is a reason why they
are still students. I know what I am SUPPOSED to hear for certain heart/valve
problems, but biological systems are kind of funny that way...they don't seem
to do exactly the what the text books say they're supposed to do.
Now, if 4/5 of cardiologists could not diagnose common heart problems, then I
would be worried.
----------------------------------------------------------------------------
Joseph T. Ho, MS II jt...@u.washington.edu
School of Medicine University of Washington
----------------------------------------------------------------------------
David Sacco (drss...@pitt.edu) wrote:
GuY M
On Mon, 5 Jan 1998 15:42:56 -0500, David Sacco <drss...@pitt.edu> wrote:
.
>Some types of GI cancer will often look an awful lot like hypochondriasis.
Again that's not an good reason because, if that was the case, it should've been checked
and ruled out.
>
>Dave Sacco
>ms-ii, pitt med
>http://www.pitt.edu/~drsst37/applicants
>
One correction; I remembered this morning that they were residents and not med students
It is MUCH easier to find something when you know what you are looking for, nevertheless
the numbers should've been higher, no matter what the circumstances were.
Maybe that's why there has been a few young athletes die on the playing fields, because
someone didn't know what they were looking for. I'm sure there is thousands of reasons
for those that could be attributed to those results, but the end result was that they
failed to recognize the danger.
++++++++++++++++++++++++++++++++++++
BS in ChemistrY, Biochemistry
Minor in Math, cs
David Sacco
On Tue, 6 Jan 1998, GuY M wrote:
> On Mon, 5 Jan 1998 15:42:56 -0500, David Sacco <drss...@pitt.edu> wrote:
> .
> >Some types of GI cancer will often look an awful lot like hypochondriasis.
> Again that's not an good reason because, if that was the case, it should've
> and ruled out.
Okay Sherlock, how would you rule out hypochondriasis? Especially if a gi
series and CT scan showed nothing at all? It's not that easy.
> It is MUCH easier to find something when you know what you are looking
for, nevertheless
> the numbers should've been higher, no matter what the circumstances were.
considerable portion of practicing cardiologists would be severely
hampered in a diagnosis without a history. It'd be like asking a
pathologist to identify the disease process without telling them where the
tissue was from or what the history suggested.
> Maybe that's why there has been a few young
athletes die on the playing fields, because
> someone didn't know what they were looking for. I'm sure there is
thousands of reasons
> for those that could be attributed to those results,
but the end result was that they
> failed to recognize the danger.
Here's some fun facts for you to look up. What percentage of people have
heart murmurs? What percentage of those people develop problems from
their murmurs?
Medicine is not as clear-cut as computer science or chemistry (which,
incidentally, were my undergraduate field of study.) Symptoms vary
greatly in their meaning based on the individual. This is one of the main
reasons that expert computer-based diagnostic systems have largely failed.
> ++++++++++++++++++++++++++++++++++++
> BS in ChemistrY, Biochemistry
> Minor in Math, cs
Dave Sacco
ms-ii, pitt med
BS in Chemistry, minor in computer science :-)
http://www.pitt.edu/~drsst37/applicants
MKNZEEJR
The reason maybe that sometimes doctors just don't give a patient enough time.
I have seen breast exams that were far too hastily done.
I have seen doctors stand up in the middle of a patients questions.
There is a vast difference in quality from one doctor to the next. Part is
education and part is dedication.
There was a GREAT piece on 60 minutes about the book and the author of the book
"Best Doctor's in America." The entire reason for the book is that people
treat docs as if they are equally qualified as each other. We do that in no
other field. They are not.
1 out of 5 of those residents DID identify the problem.
Why is that? How did they do it? What was better about them?
Let's not make excuses for the ones who failed. Let's look at the ones who
succeeded.
In my personal experience as a patient, I have been rushed, ignored, and not
had my questions answered directly more often than not.
Yes, managed care is giving docs less time but there are still docs who belive
in patient care and are dedicated to it. That is what being a good doctor is
all about.
McK
David Sacco
On 6 Jan 1998, MKNZEEJR wrote:
> The reason maybe that sometimes doctors just don't give a patient enough time.
which insist that you see more patients/given amount of time.
> There was a GREAT piece on 60 minutes
> about the book and the author of the book
> "Best Doctor's in America." The entire reason for the book is that people
> treat docs as if they are equally qualified as each other. We do that in no
> other field. They are not.
I agree that there are differences among the quality of physicians, but I
have yet to see a reliable method of objectively comparing medical care.
Some plans try morbidity/mortality, but these are skewed against the docs
who take care of the most difficult cases.
> 1 out of 5 of those residents DID identify the problem.
> Why is that? How did they do it? What was better about them?
If I gave a multiple-choice exam consisting of 5 possible answers, and
there wasn't a way to distinguish the right answer, on average 1 out of 5
would get it right and 4 out of 5 would get it wrong. The people who got
it right wouldn't be any better than those who got it wrong; they just
were luckier. A similar effect could be in place here, where a sound
could mean perhaps five possibilities. Just because some people got it
right doesn't mean they're any better diagnosticians.
Identification of pathology behind murmurs, if the resident would be
allowed a complete H&P, makes much more sense as a test.
Dave Sacco
ms-ii, pitt med
MKNZEEJR
>>> 1 out of 5 of those residents DID identify the problem.
> Why is that? How did they do it? What was better about them?
If I gave a multiple-choice exam consisting of 5 possible answers, and
there wasn't a way to distinguish the right answer, on average 1 out of 5
would get it right and 4 out of 5 would get it wrong. The people who got
it right wouldn't be any better than those who got it wrong; they just
were luckier. A similar effect could be in place here, where a sound
could mean perhaps five possibilities. Just because some people got it
right doesn't mean they're any better diagnosticians.<<
Interesting.
IF this is so - that there was a one in 5 chance and 1 in 5 did get it right,
then in essense no one got it right. And if that is the case, then the entire
test must be false. BUT is THAT so. Can anyone find the actual article and
let us know?
McK
Tan Min-Han
>One correction; I remembered this morning that they were residents and not med students
The article was published in a September '97 issue of JAMA. My archive
of the clari.news.health.misc states that "the study involved more
than 450 first, second and third-year internal medicine and family
practice residents. They were asked to detect 12 different heart
problems by listening with a stethoscope to cardiac rhythms
played on a high-fidelity tape." I'm sure those who have the energy
can help us all by seeking out the methodology of the study.
>It is MUCH easier to find something when you know what you are looking for, nevertheless
>the numbers should've been higher, no matter what the circumstances were.
In Great Britain (as here in Singapore as well), there is considerable
emphasis in medical education on the "short case", where a physical
examination is conducted with a minimal introduction, a "stem" like
"this 65 year old gentleman presents with a long history of wheezing.
Please examine his respiratory system". It is usually regarded as
unrealistic not to give some introduction, unless the case is
diagnostic or strongly suggestive of a particular system on inspection
(i.e. "Look, and proceed."
>Maybe that's why there has been a few young athletes die on the playing fields, because
>someone didn't know what they were looking for. I'm sure there is thousands of reasons
>for those that could be attributed to those results, but the end result was that they
>failed to recognize the danger.
Perhaps. You are correct in saying that medical education can
certainly be improved, and that paper may have identified a particular
area of weakness in a teaching programme of a particular university.
At the same time, leaping to conclusions about specific inadequacies
is not quite what an educated person should do - and that last
sentence sounds particularly lacking in reason.
Tan Min-Han Faculty of Medicine National University of Singapore
WWW: http://www.post1.com/~tan.min.han E-mail: tan.m...@post1.com
"The medical student is likely to be one son of the family too weak to
labour on the farm, too indolent to do any exercise, too stupid for the
bar and too immoral for the pulpit." -- Daniel Coit Gilman (1831-1908)
GuY M
On 6 Jan 1998 04:53:37 GMT, jt...@neuron.neurosurgery.washington.edu (Joseph T. Ho) wrote:
>I haven't read the report either. However, depending on the year (knowledge
>and experience) of the medical student, it is not all that concerning that a
>med students missed it (or 4/5 of med students). There is a reason why they
>are still students. I know what I am SUPPOSED to hear for certain heart/valve
>problems, but biological systems are kind of funny that way...they don't seem
>to do exactly the what the text books say they're supposed to do.
>
>Now, if 4/5 of cardiologists could not diagnose common heart problems, then I
>would be worried.
The concern is that how many will become proficient in diagnosing those problems? I
haven't read the article and I'm not aware what the distribution of the residents were,
(I,II,II, etc) I would assume that included a pool of subjects from all the different
stages. If that's the case the numbers are discouraging, since many of them will go on to
learn these differences outside the "medical student" umbrella.
++++++++++++++++++++++++++++++++++++
BS in ChemistrY, Biochemistry
Minor in Math, cs
GuY M
On Tue, 6 Jan 1998 11:50:08 -0500, David Sacco <drss...@pitt.edu> wrote:
>On 6 Jan 1998, MKNZEEJR wrote:
>> The reason maybe that sometimes doctors just don't give a patient enough time.
>Time is certainly a concern, though alot of the blame resides with HMO's
>which insist that you see more patients/given amount of time.
>
>> There was a GREAT piece on 60 minutes
>> about the book and the author of the book
>> "Best Doctor's in America." The entire reason for the book is that people
>> treat docs as if they are equally qualified as each other. We do that in no
>> other field. They are not.
>I agree that there are differences among the quality of physicians, but I
>have yet to see a reliable method of objectively comparing medical care.
>Some plans try morbidity/mortality, but these are skewed against the docs
>who take care of the most difficult cases.
There is also ways to manipulate the results to avoid errors in those extremes cases, and
that's part of the statistical analysis. It is possible that the 50% number could be
close to real life in residencies programs, I'm just speculating here. And the numbers
are lower for practicing drs. And the statistics posted lacked sufficient information to
make the distinction. I personally find that number realistic in a residency environment
were the process of learning is going on and mistakes are made.
>> 1 out of 5 of those residents DID identify the problem.
>> Why is that? How did they do it? What was better about them?
>If I gave a multiple-choice exam consisting of 5 possible answers, and
>there wasn't a way to distinguish the right answer, on average 1 out of 5
>would get it right and 4 out of 5 would get it wrong. The people who got
>it right wouldn't be any better than those who got it wrong; they just
>were luckier. A similar effect could be in place here, where a sound
>could mean perhaps five possibilities. Just because some people got it
>right doesn't mean they're any better diagnosticians.
Well this weren't problems that were impossible to distinguish with a stethoscope
therefore, this analogy doesn't apply. I like to think that the 20% percent that
diagnosed the problem correctly did so because they practiced enough to recognize the
subtle differences in the problems and not by pure luck. Sooner or later those same
residents will have to learn to differentiate the problems, for my sake, because every
physical i've had were performed with a stethoscope, and I would've hated to have a heart
related problem during a mountain bike race because someone didn't guess right.
BrewsterK
> Well this weren't problems that were impossible to distinguish
> with a stethoscope
> therefore, this analogy doesn't apply. I like to think that
> the 20% percent that
> diagnosed the problem correctly did so because they practiced
> enough to recognize the
> subtle differences in the problems and not by pure luck.
> Sooner or later those same
> residents will have to learn to differentiate the problems,
> for my sake, because every
> physical i've had were performed with a stethoscope, and I
> would've hated to have a heart
> related problem during a mountain bike race because someone
> didn't guess right.
I did read the report. Not only that, but we discussed the report in our ICM
class, and I have read several interesting responses to the report from various
sources. Almost all the responses (primarily from medical educators and
residency directors) pointed out the need for more work on basic medical
skills, HOWEVER, many of them pointed this out as a money saving issue, not a
diagnostic issue. One made the point that one reason that stethescope skills
had declined was because of technology--that there was little need to be able
to distinguish between a mitral valve stenosis and coarctation of the aorta
when both of these patients are going to immediately be scheduled for an
echocardiogram, perhaps an MRI, and other tests that are much more specific and
precise than the most skilled auscultator. It has been a couple months since I
read the article and I can't remember if the residents couldn't distinguish
between different abnormalities, or if they were unable to distinguish between
healthy and unhealthy. I believe it was an issue of not being able to
distinguish different problems. It is one issue if a physician says, "there's
a problem here, but I'm not sure what it is." and "there is no problem here."
when indeed there is a problem.
David Sacco
On Thu, 8 Jan 1998, GuY M wrote:
> On Tue, 6 Jan 1998 11:50:08 -0500, David Sacco <drss...@pitt.edu> wrote:
> >I agree that there are differences among the quality of physicians, but I
> >have yet to see a reliable method of objectively comparing medical care.
> >Some plans try morbidity/mortality, but these are skewed against the docs
> >who take care of the most difficult cases.
> There is also ways to manipulate the results to avoid errors
> in those extremes cases, and
> that's part of the statistical analysis.
objectively assess something that is inherently subjective.
> >> 1 out of 5 of those residents DID identify the problem.
> >> Why is that? How did they do it? What was better about them?
> >If I gave a multiple-choice exam consisting of 5 possible answers, and
> >there wasn't a way to distinguish the right answer, on average 1 out of 5
> >would get it right and 4 out of 5 would get it wrong. The people who got
> >it right wouldn't be any better than those who got it wrong; they just
> >were luckier. A similar effect could be in place here, where a sound
> >could mean perhaps five possibilities. Just because some people got it
> >right doesn't mean they're any better diagnosticians.
> Well this weren't problems that were impossible
> to distinguish with a stethoscope
> therefore, this analogy doesn't apply.
They were problems that were vanishingly difficult for internal medicine
and family practice residents. I read the article by the way. The method
was to supply the docs with an audio tape (not even a real patient that
they could see!) with recorded heart murmurs. They had to choose from a
multiple-choice set of answers. Residents did no better than medical
students. The test subjects were compared with practicing cardiologists.
It is not surprising that cardiologists were better at identifying the
sounds, given that they've heard about 1000 times more murmurs, virtually
every day of their career. Again, history is essential to differentiating
murmurs. Expecting students to identify sounds as well as practicing
cardiologists is rather unrealistic.
> I like to think that the 20% percent that
> diagnosed the problem correctly did so because they practiced
> enough to recognize the
> subtle differences in the problems and not by pure luck.
I'd like to think that if I were in an airplane crash, I'd survive due to
my crash landing skill, but chances are I'd be better off with a little
luck. :)
Statistically, some people were going to guess right. The fact that level
of training had nothing to do with accuracy (apart from the cardiologists)
supports the luck hypothesis.
> Sooner or later those same
> residents will have to learn to differentiate the problems,
> for my sake, because every
> physical i've had were performed with a stethoscope, and I would've
> hated to have a heart
> related problem during a mountain bike race because
> someone didn't guess right.
Why is it that people assume that if something happens to them, it's
always preventable. Unfortunately, some people keel over. That's life.
Dave Sacco
ms-ii, pitt
http://www.pitt.edu/~drsst37/applicants
Paul Grenier
According to C. Everett Koop , the former surgeon general, 67% of all
medical diagnoses in the U.S. is incorrect.
BrewsterK
> According to C. Everett Koop , the former surgeon general,
> 67% of all
> medical diagnoses in the U.S. is incorrect.
context is a wonderful thing. Is that 67% of first diagnoses, or final
diagnoses. All physicians will make a diagnosis based on history, physical
findings, etc, then revise it as they get more information. What exactly was
Koop talking about.
Also, remember that the Human body is not a car or vacuum cleaner. We didn't
design it and in many cases don't really know exactly what is going on or what
is wrong.
David Sacco
On 8 Jan 1998, BrewsterK wrote:
> sources. Almost all the responses (primarily from medical educators and
> residency directors) pointed out the need for more work on basic medical
> skills, HOWEVER, many of them pointed this out as a money saving issue, not a
> diagnostic issue. One made the point that one reason that stethescope skills
> had declined was because of technology--that there was little need to be able
> to distinguish between a mitral valve stenosis and coarctation of the aorta
> when both of these patients are going to immediately be scheduled for an
> echocardiogram, perhaps an MRI, and other tests that are much more specific and
question has moved from, "Can I identify and treat the problem" to "Can I
indentify and treat the problem using the least expensive modalities."
The fear of litigation has lead to a divergence from Ocham's (sp?) Razor,
i.e. that you should pursue the most obvious possible source first. If
somebody comes in with a headache, you want to rule out the flu before you
start scheduling CT's and MRI's.
> distinguish different problems. It is one issue if a physician says, "there's
> a problem here, but I'm not sure what it is." and "there is no problem here."
> when indeed there is a problem.
Another very good point. From the portion of the article that JAMA posted
on its web site, the test seemed to be the differentiation of disorders as
opposed to differentiation of normal from abnormal.
Dave Sacco
http://www.pitt.edu/~drsst37/applicants
David Sacco
On Sat, 10 Jan 1998, Paul Grenier wrote:
> According to C. Everett Koop , the former surgeon general, 67% of all
> medical diagnoses in the U.S. is incorrect.
Source? Context?
Dave
Gregory LaMont Casey
How many times do we hear about doctors that give antibiotics for the
flu. This is common. Now I know that many will say that this is small,
but keeping in mind that antibiotics also harm healthy bacteria and that
parasitic bacteria do develop an immunity, this is serious.
Doctors, nurses, PAs, etc., should serve as information. The healing
comes from the body of the patient. It should be the job of those of us
in science to put the healing back into the patiences hands.
**********************************************************************************************
John Sobeck
>How many times do we hear about doctors that give antibiotics for the
>flu. This is common. Now I know that many will say that this is small,
>but keeping in mind that antibiotics also harm healthy bacteria and that
>parasitic bacteria do develop an immunity, this is serious.
99% of this is patient driven. I do this rarely, but when I don't, the
patient often leaves mad, or just goes to another provider.
I was taught to be a purest, treat only indications, but many patients
make this difficult.
John
Paul Grenier
John, are you saying that you let your patients dictate your treatment?
Who's the doctor?
L. Cheek@postoffice.worldnet.att.net Jon L. Cheek
This is sad but true, often patients may view you as a "bad" doctor if you
don't "treat" them in some way. Why pay for Grandma's advice of chicken
soup, juice, and rest for flu treatment? However, we must still educate
the patient. Whenever this type situation occurred with me, and educated
my patient that antibiotics won't kill a virus and that they could actually
wind up making things worse. More often than not they were happy with my
treatment, or non-treatment as the case may have been.
JLC
John Sobeck <babydo...@pacifier.com> wrote in article
<34be81a8...@news.pacifier.com>...
John Sobeck
I actually will not treat on demand, I was just stating the fact as a
reply to a previous post.
Many meds, tests, ultrasounds, MRIs, HYSTERECTOMIES, are requested by
the patient whether indicated or not. I have lost patients due to my
refusal.
I still try to be a purist!
john
