Misdiagnosis and Delay in the Diagnosis of Cancer
Misdiagnosis of cancer related conditions occurs with increasing frequency with error rates in early detection ranging from an estimated 1.4% in cancer biopsies to a staggeringly common 25 – 40% rate in critical or intensive care. Worldwide surveys of patients also indicate the chance of experiencing misdiagnosis to range from 8% to 40%. This misdiagnosis one of the most common types of medical mistakes.
Inevitably, the causes of misdiagnosis are multifactorial, typically though, the list will include erroneous GP symptom interpretation, wrong laboratory tests being requested, improperly performed tests or even errors in imaging interpretation. Less commonly but nonetheless important is patient error, usually as a consequence of misreporting of symptoms, allowing perhaps stoicism or even exaggeration to colour the way that symptoms have appeared or the order that they appeared.
There are various types of misdiagnosis, the first of which we can label the “completely inaccurate diagnosis” these are just plain wrong, regardless of the reasoning behind the error. Fortunately, they are relatively rare, oftentimes, of course, symptoms will overlap and what appears to be an aggravated lymph node that will not settle down today, can perhaps be a reaction to infection but could also be lymphoma. The issue here is how long the initial diagnosis goes untested before it becomes unreasonable.
Secondly perhaps, we have what may be recorded as “partial misdiagnosis”. This may include a wrong subtype of disease or an underlying condition, which may be secondary to the main disease or condition. This in itself may well lead to further investigations. A tumour may be labelled as benign but may not remain stable in that state. If the identity is not properly investigated then while the detection of the presence of the tumour may have been conducted optimally the treatment options will not be correct. Closely related to misdiagnosis or partial misdiagnosis, the patent may also be subject to a “compound misdiagnosis” where an initial diagnosis leads to a cascading error in medication type or dosage. The reaction to this medication (sometimes referred to as treatment bounce) may well lead a clinician to further investigations that are unnecessary or treatments that are inappropriate. Lastly on our list (by no means is this an exhaustive list) is the often highly confusingly “stage misdiagnosis”, this occurs when the actual right diagnosis has been reached but the staging of the development of the tumour has been misread, this often leads to treatment bounce or ineffective treatment regime.
Misdiagnosis, it appears, does not occur for all conditions in proportion but it does follow specific patterns. Some conditions are certainly more difficult to diagnose, whereas common familiar conditions are less commonly misdiagnosed. Some diseases are over- diagnosed whereas other conditions are more commonly overlooked. How can this be avoided? The increasing familiarity by clinicians with the published clinical guidelines by the National Institute of Heath and Clinical Excellence (Nice) has contributed to some stemming of the problem. So too has the adoption of a standard clinical educational system across the UK. Standard clinical procedures and methodology in detection, interpretation and diagnosis can only be a good thing and this standardisation in training across clinical boundaries has led to greater detection and collation of the data, which if nothing else, has contributed to the research in these areas.
Systemic improvements in clinical education have happened in combination with increased patient awareness and perhaps somewhat controversially, the widespread use of the internet by patients to educate themselves in condition symptomology. Patient awareness is not without problems for treating clinicians, the increase in patient sensitivity to anxiety and the tendency to “fear the worst” has to be dealt with. The clinician often has a mountain of interpretation to climb before confirming or rejecting the patients own diagnosis, however, with this approach at least most symptoms are explored.
Ultimately, it takes considerable faith by a patient in their GP to consistently and wholeheartedly follow recommendations that seem to be having no effect whatsoever on the reduction of the symptoms. The process of referral and second opinions should not be shied away from. If however, as is often the case, the disease has spread or the staging advanced and the condition has been exacerbated by the delay incurred by misdiagnosis then ultimately this may well have a significant effect on the individual who may have to face loss of earnings and other expenses and hardships while a protracted chemical or radiotherapy regime is followed, which could otherwise have been avoided.
At this point the misdiagnosis or delay incurred as a consequence is likely to be the bedrock of a negligence claim against the clinician. Such an action can at least bring about the discipline and attention that the patient should have expected from day one.