Welcome back! Last week, we talked about POTS, a disorder that can cause lightheadedness (occasionally with fainting), difficulty thinking and concentrating (brain fog), fatigue, intolerance of exercise, headache, blurry vision, palpitations, tremor, and nausea. If you missed that blog and would like to catch up, click HERE.
This week, we are going to talk about getting a misdiagnosis. Many of us have experienced this, but you may be surprised to know how often this actually happens. Let’s chat.
Is It Mental Health or Medical Health?
One of the things that often seem to slip under the radar is a urinary tract infection (UTI), especially in the elderly. We will see our loved ones experiencing hallucinations, confusion, insomnia, and pain, but they get diagnosed with Sundowners (a common issue for folks with dementia) or simply being “cranky” or “attention seeking”. They may be diagnosed with Depression or Delusional Thinking.
Symptoms of a UTI
Most people think of a UTI as difficulty urinating, a change in urine smell, darkening urine color, painful urination, itching, and fever. However, some UTIs present without clear symptoms.
When an older person has a UTI, the symptoms are different from a younger person. There might not be any painful burning during urination – always a typical sign. This is because as you get older, your immune response changes – it’s part of normal aging.
Delusions, Hallucinations, and Sepsis
Detecting UTIs can be difficult, particularly with someone whose communication may be impaired due to dementia. Sudden changes in behaviors and an increase in symptoms may indicate that your loved one has a UTI.
Behavior changes and causes that seem to affect one’s personality may include sleeping issues, anxiety, depression, confusion, aggression, delusions, hallucinations, and paranoia. It can be quite startling. They may start thinking they are in 1964 and they will be adamant about it.
Before she passed away, my mama was in the hospital due to a change in behavior. She kept saying, “my stomach hurts”. She thought it was 1964 and she was in the hospital to have a baby. I said, “Mama, I AM that baby”. She insisted she was pregnant and I finally said, “No…you have a UTI”.
She looked me in the eye and said with quite a bit of haughtiness, “Well, I don’t know who told you that, but they really told you a big one! You don’t get pregnant from a UTI!”. Touche.
Several days later she came home cured and didn’t remember a thing about her illness.
If overlooked for too long, a patient can become septic and potentially die.
According to the AARP, Sepsis is number 7 out of the top 10 MOST COMMONLY MISSED OR DELAYED DIAGNOSES BY MEDICAL CONDITION.
Derived from 836 relevant cases from patient safety incident reports, malpractice claims, morbidity and mortality rounds (conferences that review patient deaths and complications), and focus group responses. Reported in JAMA (Journal of the American Medical Association) Network Open.
- Colorectal cancer
- Lung cancer
- Breast cancer
- Myocardial infarction (heart attack)
- Prostate cancer
- Bladder cancer
- Pulmonary embolism
- Brain hemorrhage
Previous research supports the findings of this latest report. Nevertheless, a few other conditions can be added: Pneumonia, heart failure, kidney failure, and urinary tract infections are among those often missed in the primary care setting, a study published in JAMA Internal Medicine found. Fractures, abscesses, and aortic aneurysms are also commonly missed, according to another report published in the same journal.
“Missed diagnoses are common, and they’re often overlooked,” says study coauthor Gordon Schiff, M.D., associate director of Brigham and Women’s Center for Patient Safety Research and Practice and an associate professor of medicine at Harvard Medical School in Boston.
In fact, research shows that some 12 million American adults are misdiagnosed annually in outpatient settings. That’s about 5 percent of patients, though some experts say the percentage is likely higher. And it’s estimated that 40,000 to 80,000 people die each year from diagnostic failures in U.S. hospitals. What’s more, a report from the National Academies of Sciences, Engineering, and Medicine states that most people will experience a missed or delayed diagnosis in their lifetime, sometimes with devastating consequences.
Diagnostic Error Defined
WHAT IS A DIAGNOSTIC ERROR?
The National Academies of Sciences, Engineering, and Medicine defines diagnostic error as the failure to establish an accurate and timely explanation of the patient’s health problem or failure to communicate that explanation to the patient. It can be the result of:
- A delayed diagnosis
- A wrong diagnosis
- A missed diagnosis
Source: Society to Improve Diagnosis in Medicine
How do I know if I have been misdiagnosed
Well, you can’t know for sure, and the internet can be very confusing. Research on the internet is often incomplete and fails to address all of the variables. That said, there are some things to watch for.
1. Your Symptoms Overlap with Multiple Conditions
If you have symptoms that can match more than one condition, it helps to ensure your doctor is doing everything possible to rule out specific diagnoses. In many situations, it’s a lack of experience that causes a doctor to provide one diagnosis without looking at other possibilities when symptoms overlap.
2. Your Doctor Didn’t Get All Information
When you see your doctor, you should be providing important information about your condition. If your doctor doesn’t ask questions or it feels as though he or she isn’t collecting all information from you before diagnosing your condition, it could be a problem.
3. You Didn’t Receive Proper Testing
Testing and imaging can help your doctor properly diagnose your condition. Far too often, doctors don’t go through the motions of providing multiple tests. If your doctor only orders one test before diagnosing you or claiming there’s nothing wrong with you, this may be a red flag.
4. Your Second Opinion Doesn’t Match the Diagnosis
If you feel your diagnosis is incorrect, you may seek a second opinion with another doctor. In these situations, your second opinion may be much different than the initial diagnosis. If this is the case, you may have received a misdiagnosis.
5. Your Treatment Is Ineffective
Even if you trust your doctor’s diagnosis and go through with whatever treatment option they prescribe, you may encounter an issue where treatment is not working. When your treatment doesn’t work, it may mean that your doctor didn’t diagnose you correctly.
Be your own best advocate
It’s important to advocate for yourself. It’s your body. Your doctor won’t go home in pain, they won’t be up all night with nausea, and they won’t miss out on fun events or work. You will. So you need to advocate for more testing, a second opinion, or a change in treatment if the current one isn’t working for you. If your doctor won’t listen, then it may be time to find one that will.
As always, this blog is not a replacement for sound medical advice. I am not a doctor. Please make an appointment to see your healthcare provider and put a good plan in place that works for you and the needs of your body.
That’s all I have for you this week, dear reader. I’ll see you back here next Wednesday to share another cup of coffee. Until then, be good to yourself and each other.
Mind, Body, Spirit…Osteopathic Doctors treat the whole person, not just the ailment. Is your PCP a DO? Would you like to learn more about Osteopathic Physicians? Click HERE!