How many patients (and doctors) are unaware of the range of variability in diagnoses that can derive from the same pathology sample? How much accepted ‘certainty’ is, in fact, ‘uncertain’? Read on, and you may never want to accept a diagnosis without getting a second opinion – or a third.
When Diagnostic Uncertainty Hits Home. Joann Elmore. BMJ Opinion, 28 June 2017.
The article includes some useful links eg http://www.nejm.org/doi/full/10.1056/NEJM199412013312206
‘Variability in Radiologists’ Interpretations of Mammograms. Joann G. Elmore, Carolyn K. Wells, Carol H. Lee, Debra H. Howard, and Alvan R. Feinstein
N Engl J Med 1994; 331:1493-1499 December 1, 1994 – which calls for efforts to improve accuracy and reduce variability in interpretations of mammography.
Posted in biopsies, Breast Cancer, breast screening, Campaigns, cancer, citizen safety, diagnoses, harms, healthcare modernisation, information, medicine's flaws, Over-medicalisation, overdiagnosis, patient safety, patient/doctor communication, Public safety, Screening, Screening Mammography
Tagged health, medical, science, testing
In my rapid response to this BMJ article I should have mentioned GP payments that were given for not referring patients. Does anyone else have the sense that there are also cut-off points for referral, diagnostic investigations or treatments at say age 75? Or above? That’s certainly the impression I’m getting from friends and colleagues.
Prescribing incentives feel grubby because they are. Margaret McCartney. BMJ 2017;357:j2695
In this New England Journal of Medicine paper, Welch and colleagues discuss whether wealthier people receive too much care – ie more than is good for them. “Excessive testing of low-risk people produces real harm, leading to treatments that have no benefit (because there is nothing to fix) but can nonetheless result in medication side effects, surgical complications, and occasionally even death.’
Income and Cancer Overdiagnosis – When Too Much Care is Harmful. H Gilbert Welch, Elliott S Fisher. N Engl J Med 376;23, 2208-2209. June 8 2017. http://www.nejm.org/doi/pdf/10.1056/NEJMp1615069
A recent feature in the Medical Defence Union Journal offers insight into the doctor-patient relationship from a doctor-patient.
‘The overwhelming realisation was that despite being highly qualified, intelligent and driven professionals, we often forget the simple things. The fact that I am here and able to write this is testament to the good care that I received. However, the truth is that it’s the difficult, painful moments and words that are the ones that I and, I suspect, other patients remember forever, and which have a lasting effect on us’ writes Dr Nia Wyn Davies… ‘Patients respect honesty from their doctors. Where there is no hope we owe it to them to tell them so, tactfully and gently. But whilst there is light, however dim, at the end of the tunnel, we must reassure our patients and their relatives of this and allow them to hope, whilst we manage the reality.’
Since she is a doctor, it is doubly shocking that her concerns were dismissed. The need for compassion in healthcare is just one of the lessons highlighted by this article.
N W Davies. The receiving end – a doctor’s insight. Medical Defence Union Journal.