Difficulties With Diagnosis

I’m impressed that the Boston Globe printed a number of insightful letters in response to its Mistakes that matter
article, which discussed the case of two patients whose prostate cancer
biopsies got mixed up. (One had cancer, the other didn’t. The one
without cancer got surgery as a result of the mixup, the one with
cancer had delayed treatment and possibly negative consequences as a

Two of the four letters are from patients who were tested for
cancer. The best is one from Irving Sacks of Peabody, documenting how
he searched widely for alternative treatments after being diagnosed
with cancer of the esophagus. In the end he found out from a medical
center in California that he had another condition –not cancer– and
didn’t need the proposed surgery to remove his esophagus. He says (and
I concur):

When confronted with a life-threatening
medical assessment, do not rely on a single diagnosis, and, when
getting a second opinion, go outside the network, even to another city.

Edgar Dworsky of Somerville wasn’t persuaded that he had prostate
cancer after the first pathologist said the slides were “suspicious for
cancer,” so he took the same slides to another pathologist who said he
“definitely” had prostate cancer and a third who said the slides were
“highly suspicious for prostate cancer.” Based on that set of findings
he’s decided he doesn’t (yet) have prostate cancer and has embarked on
a program of watchful waiting rather than active treatment. At least
from what he’s written it’s a little hard to follow his logic but for
his sake I hope he’s right.

Arthur Rosenthal of Salem points to a New England Journal of Medicine article (Mortality Results from a Random Prostate-Cancer Screening Trial)
that showed screening didn’t make it less likely that those tested
would die from cancer. As Rosenthal points out, screening may not save
you from dying from cancer but it can induce worry by making you think
you do have cancer. I agree with that.

Finally, Dr. Donald Ross,
past president of the Massachusetts Society of Pathologists, but
writing on his own behalf, says the problem is profit-driven corporate
labs. Unlike hospital-based practices such as his, which he asserts
follow precautions to avoid mix-ups, such labs drive through so much
volume that they increase workload and lead to errors. I’m willing to
keep an open mind on Ross’s point, but he doesn’t cite evidence showing
lower error rates. I’m also unconvinced that profit-seeking companies
are any more interested in revenue than independent physicians.

In any case I’m glad to see the Globe provide so much information on the practical challenges in getting the right diagnosis.

David E. Williams is co-founder of MedPharma Partners LLC, strategy consultant in technology enabled health care services, pharma, biotech, and medical devices. Formerly with BCG and LEK. He blogs regularly at the Health Business Blog, where this post first appeared.

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