Should you trust your doctor?
Jed Stuber · Apr 30, 2017
A recent Mayo Clinic study on the “extent of diagnostic agreement among medical referrals” made national headlines:
- “Study finds more than 20 percent of patients are misdiagnosed.”
- “1 of 5 patients with serious medical conditions are misdiagnosed.”
- “Get a second opinion—doctors usually aren’t right the first time.”
- “First medical diagnosis often incomplete or plain wrong, study finds.”
Dr. Michael Joyce, who used to work for Mayo Clinic, debunked those headlines:
- Much of the Mayo Clinic workload is dealing with difficult cases referred there. You can’t use it to draw conclusions across the board.
- Media reports left out the finding that the Mayo Clinic was able to make a better defined diagnosis two thirds of the time.
- The sample was very small and there was no follow-up over time.
The Mayo Clinic has tried to study this issue before, and it’s not easy.
One attempt was made to review medical literature, but there was great difficulty determining which keywords should be searched to try to find cases of changed diagnoses. The study “concluded” that somewhere from “10 to 62 percent of second opinions yield a major change in diagnosis."
An attempt was made to separate out patients with a poorly defined diagnosis. Ninety percent of them don’t get a better diagnosis from a second opinion. Hard cases are hard cases.
A couple of Proverbs, which aren’t about medicine or science, do seem applicable.
“The one who states his case first seems right, until the other comes and examines him.”
“Without counsel plans fail, but with many advisers they succeed.”
The issue of medical errors is of greater concern than disagreements over an exact diagnosis.
Last year a British Medical Journal article made headlines for reporting that medical errors are now the third leading cause of death, after cancer and heart disease. More than 250,000 Americans die every year from “iatrogenic” causes, meaning their death is caused by a physician’s or hospital’s activity, manner, or therapy. The doctors who published the article say the evidence proves the health care system is letting patients down. They also add a qualifier that the data being collected leaves some things to be desired. Reporting has to line up with insurance codes, which “are designed to maximize billing rather than capture medical errors.”
Dr. Joseph Mercola, owner of one of the world’s most visited health websites, wonders why it took so long to get the media’s attention. The Journal of the American Medical Association first reported similar findings in 2000. A 2013 article in the Journal of Patient Safety came up with an even higher number of 440,000 deaths per year.
The two biggest factors are prescription medications and hospital infections.
Adverse drug reactions
Dr. Mercola sums up the problems related to prescriptions:
- One study showed that, from 1976 to 2006, almost a quarter-million deaths were coded as having occurred in a hospital setting due to medication errors. An estimated 450,000 preventable medication-related adverse events occur every year.
- The costs to society of adverse drug reactions are more than $136 billion annually—greater than the total cost of cardiovascular or diabetic care. Adverse drug reactions cause injuries or death in one of five hospital patients.
- The reason there are so many adverse drug events in the U.S. is that so many drugs are used and prescribed—and many patients receive multiple prescriptions at varying strengths, some of which may counteract each other or cause more severe reactions when combined.
Betsy McCaughey is passionate about raising awareness of the hospital infection problem. She’s the former lieutenant governor of New York, and founder of the Committee to Reduce Infection Deaths.
McCaughey says nasty, life-threatening infections like C. Diff are rampant because hospitals refuse to acknowledge that their cleaning standards are inadequate.
C. Diff can survive for months on almost anything: uniforms, wheelchairs, bedsheets, call buttons, you name it.
The Mayo Clinic reduced C. Diff by 79 percent in a pilot project by doing one thing: wiping the frequently touched surfaces around patients’ beds once a day with a bleach wipe.
McCaughey says it is an outrage that hospitals won’t adopt this practice. Doctors, nurses, and other hospital personnel will often say the problem is caused by antibiotics, which can play a role by weakening gut bacteria and making people more susceptible to infection.
But The Mayo Clinic study is conclusive in McCaughey’s estimation. She does not mince words, and insists that the medical community is lying to patients.
Her advice is, “If you’re going to the hospital to visit someone you love, don’t bother with flowers or candy. Instead, bring a canister of bleach wipes and a pair of gloves. You could be saving a life.”
The third-party payment problem
A big problem facing patients who want to evaluate the quality of health care is that third-party payment can drive a wedge between the customer and the provider.
Some doctors avoid third-party interference by only accepting cash payment directly from their patients, a model called Direct Primary Care.
DPC doctor Bruce Jung says:
My patients have come to understand that I work directly for them and not for a health insurance company, the federal government, or their employer. In the past I was mainly paid by these other third-party payers and so in essence was working for them and not the patient. In a typical fee-for-service office, a patient is not much more than a tool from which to obtain the best ICD-9 diagnosis code possible to justify the highest reimbursable CPT procedural code possible to bring in the most revenue possible with each encounter. In our model I am paid directly by the patient, and so I am motivated ethically, financially, and medically to do what is in their best interest alone.
The transparency problem
Unfortunately, price and quality indicators that are available in other industries are obscured in health care.
Healthcare Bluebook, a service now available to Samaritan members through their Dash account, is designed to take on this challenge.
Dr. Jeff Rice founded Healthcare Bluebook after he had an eye opening experience trying to find out the cost of a foot surgery for his son. At one facility it would cost $15,000, at another $1,500. Incredibly, it could be done by the same surgeon at either facility!
Healthcare Bluebook allows patients to search for specific treatments in their area, and then view quality and cost comparisons of the providers in their area. It is common for the costs to vary by 400 percent in the same city.
That’s not all.
According to Healthcare Blue-book’s data, the providers with the highest quality ratings are usually very competitive on price. It is not true that you have to pay the most to get the best.
Despite these challenges and many others, we have to rely on doctors to some degree. Doctors bring expertise to the table.
On the other hand, we shouldn’t be naive. We wouldn’t want to hire a contractor to remodel our kitchen without at least investigating a few things. What’s his reputation? Have others had good or bad experiences? Does he use quality materials? Are his prices competitive? Would a different contractor do it a different way?
Healthcare Bluebook offers an extensive guide for understanding your treatment options and talking to your doctor, including a list of questions you may want to ask. Click here to check it out.