- The Washington Times - Monday, December 26, 2005

Doctors, even the best of the best, don’t always have the right prescription the first time around.

It’s up to patients to make sure their doctors are doing everything within reason to ensure their good health. Mistakes happen, but they happen less often when both doctor and patient work in tandem.

The medical field is trying to stem the tide of what’s known as system errors. In 1997, the American Medical Association created the National Patient Safety Foundation toward that end, and in December 2004 it partnered with the Institute for Healthcare Improvement with the goal of saving 100,000 lives that might otherwise be lost by medical errors through June 2006.

Dr. Nancy Nielsen, speaker of the American Medical Association’s house of delegates, wants to make it clear “nobody makes mistakes as a choice.”

Dr. Nielsen says the complications inherent in medical care, from prescribing medications to assigning treatments, can be fraught with educated guesses.

The simple act of picking up a medication can cause problems if something goes awry.

Take medications with similar-sounding names, like Xanax, used as a tranquilizer, and Zantac, prescribed to battle stomach acid. One of Dr. Nielsen’s patients once got Xanax instead of Zantac at the local pharmacy and had the wherewithal to double-check with her before taking it.

“Everybody worries about lookalike or sound-alike drugs,” she says.

Patients also need to keep tabs on any test results promised by their doctors.

Most doctor’s offices insist the physician in charge signs off on test results to make sure important information isn’t overlooked, Dr. Nielsen says. Still, no system is foolproof. She suggests patients check back with the doctor via e-mail to avoid being put on hold indefinitely.

“Communication is the key. Mistakes happen more often in the areas of hand-off,” she says. That can occur when a patient moves from, say, the intensive care ward to another part of the hospital. The patient’s information has to be written again and sometimes bits of information get lost in translation.

One simple way to stop mistakes before they happen is for patients to keep an up-to-date list of their complete medical history to give to their doctors.

“I’ve been in practice 23 years and I can count on both hands how many times that happened,” Dr. Nielsen says.

Sherry Marts, vice president for scientific affairs for the Society for Women’s Health Research in the District, brings her doctor such a list every time.

Ms. Marts says the paper includes her medical history as well as information about any medications she may be taking plus how her parents and grandparents died.

That kind of deep history can help doctors avoid misdiagnoses, particularly in cases involving autoimmune diseases.

“This isn’t about blaming the doctors. These diseases can have vague symptoms,” Ms. Marts says. In recent years, researchers have learned these diseases have a hereditary component, she says, making family history charts crucial to a proper diagnosis.

Some misdiagnosed conditions are based on one’s sex.

Women suffer undiagnosed heart attacks far more often than men, she says, in part because they don’t exhibit classic symptoms like crushing chest pain and numbness in the left arm. The previously held belief that very few women younger than 50 suffer heart attacks also leads to misdiagnosed attacks, she says.

Diseases like epilepsy can be so complicated, even for specialists, that mistakes are hard to avoid.

Peter VanHaverbeke, spokesman for the District-based Epilepsy Foundation, says patients can’t expect their doctors to “know all things about all diseases.”

Epilepsy is one of many complex conditions doctors must consider when diagnosing a patient. And that’s before the treatment begins.

“There are nearly two dozen medication options that could be used individually or in combination [for epilepsy patients],” Mr. VanHaverbeke says.

Most epilepsy patients receive proper treatment from their primary care physician, he notes.

Sometimes doctors mistakenly cling to existing treatments when new, superior methods are hitting the marketplace.

“In the last decade or so there have been a number of new-generation medications,” he says. “Physicians tend to stay with the therapies they know best and are using … yet newer medications tend to be more effective and have fewer side effects.”

Surgery for epilepsy patients is one generally accepted therapy, he says, yet a small number of physicians still feel it’s too risky.

For some, a doctor’s opinion can be the start of a fact-finding mission toward better health.

Nancy Davis, creator of the Race to Erase MS annual gala, knows firsthand how traumatizing an initial diagnosis can be. Fourteen years ago she learned she had multiple sclerosis, a degenerative disease for which there is no cure.

“I was told to go home and go to bed and that I’d never walk again,” Ms. Davis recalls.

She didn’t take the information lying down.

“I had the wherewithal to be on top of things and get a second opinion,” she says. “The brightest of people don’t understand the importance of a second opinion.”

A sound doctor won’t be put off by that choice, says Ms. Davis, whose forthcoming book “Lean on Me” details how people can stay informed when diagnosed with a serious medical condition.

“Any doctor who questions you getting a second opinion, you should run out the door. If they have a strong sense of self, they’ll welcome a second opinion.”

Ms. Davis went beyond a second or third opinion. She created a foundation aimed at eradicating MS.

“You have to empower yourself, do the research, read every book you can [on the subject],” she says.

And don’t be afraid to question one’s doctor.

For some people, “Doctors are God to them. They’re afraid to ask questions,” she says.

Some medical conditions can give doctors fits given their slow onset and vague symptoms. Lung cancer tends to be “very asymptomatic and slow moving,” says Laurie Fenton, president of the nonprofit Lung Cancer Alliance.

“It’s not so easy to detect and often is misdiagnosed. Its symptoms are so much like other diseases,” says Ms. Fenton, whose group advocates on behalf of those suffering from lung cancer. “There are no nerves in lungs. You don’t feel a nodule growing until it’s gotten so big that it presses on an airway.”

She says the most common mistake made by doctors regarding lung cancer is that they often misdiagnose it as bronchitis, adding misdiagnoses with lung cancer patients makes it one of the top reasons for malpractice lawsuits.

Ultimately, it’s up to the patient to make sure his or her health care is the best it can be.

“In a broad sense everyone needs to be their own advocate,” she says.



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