Thinking aloud: Patient safety, misdiagnosis and ME

[ScottTriGuy]

I was at an inaugural national patient safety advocacy conference today and it got me thinking. We were deciding on our focus area. Much of patient safety work seems to focus on hospital and pharmacy settings. Among the material were definitions of some terms, including 'patient safety incident'.


Patient safety incident: An event or circumstance which could have resulted, or did result, in unnecessary harm to a patient. There are three types of patient safety incidents:

• Harmful incident: A patient safety incident that resulted in harm to the patient. "Replaces preventable adverse event”
• Near miss: A patient safety incident that did not reach the patient and therefore no harm resulted.
• No-harm incident: A patient safety incident that reached the patient but no discernible harm resulted.

I'm not sure how many misdiagnosis, that later turned out to be ME, would be captured in the incident reporting under these definitions. Theoretically it would be captured under 'harmful'.

Scenario: someone goes to their GP with symptoms of nausea and fatigue. Routine tests come back normal. The physician attributes symptoms to stress / depression / anxiety. Physician prescribes an anti-depressant. There is no further biological investigation.

Furthering the scenario: 5 months later the person is diagnosed with cancer.

Will that misdiagnosis be captured in the reporting?

Twisting the scenario: instead, 5 months later the person is diagnosed with ME.

Will that misdiagnosis be captured in the reporting?

I guess it would depend on how incidents are operationalized. Perhaps some health care systems would capture the misdiagnosis that was later cancer.

But I would bet dollars to donuts the vast majority (if any) of patient safety incident reporting do not capture misdiagnosis that may precede ME diagnosis...or the harm of CBT/GET, or the harm of denial of appropriate symptom treatment, or the psychological harm of disease denial.

And that's just ME. Many other invisible illnesses are similarly not being included in patient safety incident reporting.

But if incident reporting was operationalized to reach back to the GPs office, then the misdiagnosis that precede ME may be captured, and by extension ME. I'd like to see how that data turns out. Could be useful in advocacy.

(Not so fun fact: 1 person dies every 17 minutes of medical error in a Canadian hospital. That doesn't include those that die from medical error at home.)

 

[Snowdrop]

Thanks for taking the effort to do this @ScottTriGuy

It would be a very useful and insightful statistic to find (eventually) how many MD's are diagnosing depression that then turn out to be ME. so many implications for pharma, MH services, and ultimately for the person diagnosed.

I hope some useful protocols come from it.

 

[Perrier]

I was at an inaugural national patient safety advocacy conference today and it got me thinking. We were deciding on our focus area. Much of patient safety work seems to focus on hospital and pharmacy settings. Among the material were definitions of some terms, including 'patient safety incident'.


Patient safety incident: An event or circumstance which could have resulted, or did result, in unnecessary harm to a patient. There are three types of patient safety incidents:

• Harmful incident: A patient safety incident that resulted in harm to the patient. "Replaces preventable adverse event”
• Near miss: A patient safety incident that did not reach the patient and therefore no harm resulted.
• No-harm incident: A patient safety incident that reached the patient but no discernible harm resulted.

I'm not sure how many misdiagnosis, that later turned out to be ME, would be captured in the incident reporting under these definitions. Theoretically it would be captured under 'harmful'.

Scenario: someone goes to their GP with symptoms of nausea and fatigue. Routine tests come back normal. The physician attributes symptoms to stress / depression / anxiety. Physician prescribes an anti-depressant. There is no further biological investigation.

Furthering the scenario: 5 months later the person is diagnosed with cancer.

Will that misdiagnosis be captured in the reporting?

Twisting the scenario: instead, 5 months later the person is diagnosed with ME.

Will that misdiagnosis be captured in the reporting?

I guess it would depend on how incidents are operationalized. Perhaps some health care systems would capture the misdiagnosis that was later cancer.

But I would bet dollars to donuts the vast majority (if any) of patient safety incident reporting do not capture misdiagnosis that may precede ME diagnosis...or the harm of CBT/GET, or the harm of denial of appropriate symptom treatment, or the psychological harm of disease denial.

And that's just ME. Many other invisible illnesses are similarly not being included in patient safety incident reporting.

But if incident reporting was operationalized to reach back to the GPs office, then the misdiagnosis that precede ME may be captured, and by extension ME. I'd like to see how that data turns out. Could be useful in advocacy.

(Not so fun fact: 1 person dies every 17 minutes of medical error in a Canadian hospital. That doesn't include those that die from medical error at home.)

Dear Scott
You are really an angel doing all this work; thank you so much.
My daughter's whole nightmare began with errors. She had a pilonidal cyst, which was opened at Women's college. The doctor did not give an antibiotic (important considering the area), or adequate pain killer. The cut was deep and raw and 1 inch long. She was sent home as it was day surgery. Yes, overnight she got an infection, which they said was life threatening. They plied her with 7 antibiotics IV. After a week on the ward, she contracted Clostridium Difficile (tells you about how clean our Canadian hospitals are); the Cdiff lasted 4 months (she was entirely bed bound) and no normal state returned: ME reared its monstrous head. There were, as you can see, errors: no antibiotic (every usa doctor whom I have spoken to told me that for this cyst opening they always give one.) And then hundreds and thousands died from difficile. Dr Borody in Australia said that Canada had the most virulent strains of cdifficle. There is no excuse for this. And now a young person's life has been utterly detonated. And there are countless tragedies like this.

 

[Little Bluestem]

I would bet dollars to donuts

A lot of fancy donuts cost a dollar or more now. Your showing your age.

It would be a very useful and insightful statistic to find (eventually) how many MD's are diagnosing depression that then turn out to be ME.

Or a variety of other things. Anti-depressants seem to be doctors' favorite toy right now.

 

[Sean]

It would be a very useful and insightful statistic to find (eventually) how many MD's are diagnosing depression that then turn out to be ME.

Misdiagnosis cuts both ways.