Misdiagnosis in America

In April 2014, a paper was published that approximately 12,000,000 American adults are misdiagnosed every year in outpatient settings.  This means that at least 5% of outpatient clinician interactions yield the wrong diagnosis.  Up to 60% of these errors has the propensity to harm patients. 

A 1999 report found that 44,000-98,000 Americans die annually due to medical errors.  Most of these occurred in hospital settings.  Multiple studies found that autopsied patients who died in the hospital and found that up to 47% of the time, they were misdiagnosed.  In medical intensive care patients, in 26% of cases, the cause of death was missed as a clinical diagnosis.  In almost all of those cases, accurate diagnosis would have resulted in a change in treatment and prolonged survival.

Radiology results were found to be significantly error prone.  They failed to detected abnormalities 25-32% of the time and yielded an incorrect diagnosis about 2% of the time.  These statistics have been replicated numerous times.  80% of errors are perceptual, in which the abnormality is present but not noticed by the radiologist.  Even when using one, very experienced radiologist for all radiology reporting, the error rate was 25-30%.

Often, a physical disease is diagnosed as psychiatric.  This occurs 41-83% of the time, depending on which study is used as reference.  This occurs disproportionately to women, regardless of race.  This is probably because women seek therapy far more frequently than men.  It is also possible that this occurrence is the reason why women are said to have much higher rates of depression, anxiety and somatization disorders.   

Women continue to be subjected to subtle sexist discrimination.  Disorders that cause depression, anxiety, somatization, anorexia, hysteria, histrionic personality or dissocation are far more likely to be diagnosed in women as psychiatric, regardless of whether or not there is an underlying physical cause.  Depression is thought to be diagnosed incorrectly in women 30-50% of the time.  About 70% of prescriptions for antidepressants are given to women, many without proper diagnosis or monitoring.  This is especially problematic as depression is expected to be the leading cause of disability and second largest killer after heart disease by 2020. 

There are hundreds of physical diseases that cause psychiatric symptoms, including mast cell disease.  Hyperthyroidism is a good example.  Hyperthyroidism can cause incessant tension, restlessness, agitation, inability to relax, flight of ideas, insomnia, excitability, irritability, emotional lability and severe, chronic anxiety.  Patients with hyperthyroidism are often misdiagnosed as having bipolar disorder, despite also having diarrhea, puffy red eyes, and increased appetite with accompanying weight loss.  Medications for bipolar disorder exacerbate hyperthyroidism, and some patients are only diagnosed correctly after years of spiraling. 

People of color have particular reasons to distrust the medical community.  There is a long and graphic history of people of color being victimized in the name of research, eugenics, and “public health.”  There are confirmed reports of African-American, Chicana and Asian-American women being sterilized under the guise of another medically necessary surgery.  It is estimated that from 1938-1968, 1/3 of Puerto Rican women of childbearing age were sterilized.  The Tuskegee Syphilis Experiment, while likely the most famous abuse of people of color by the  medical establishment, is only one example of many. 

There is also a well-established positive correlation between racism and overdiagnosis of serious disorders and underdiagnosis of less serious ones.  There is some indication that this phenomenon also extends into interactions with the LGBTQ community.  Latinos, African-Americans and Asian Americans are more likely to feel disrespected by medical professionals by whites.  18% Latinos, 16% African-Americans and 13% Asian Americans feel disrespected because of their inability to pay or speak English.  32% Latinos, 25% Asian Americans and 23% African-Americans said they had problems understanding their doctor and felt they could not ask questions, compared to 15% of whites.  15% African-Americans, 13% Latinos, 11% Asian Americans felt they would receive better healthcare if they were of another race, compared to only 1% of whites.

Misdiagnosis continues to be a problem in the US.  Discrimination on the part of providers leading to misdiagnosis is a well established phenomenon.  This disproportionately affects women and racial/ethnic minorities.

References:

Singh, H, et al.  2013.  The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations.  BMJ Qual Saf. 

Scarborough, Norman.  2008.  Medical misdiagnosis in America. 

Hollar MC. The Impact of Racism on the Delivery of Health Care and Mental Health Services. Psychiatr Q. 2001;72:337-345.

 

Suite, Derek, et al.  2007.  Beyond misdiagnosis, misunderstanding and mistrust: Relevance of the historical perspective in the medical and mental health treatment of people of color.  Jour Nat Med Assc.  2007: 99, 879-885.

Klonoff, Elizabeth, Landrine, Hope.  Clinical Medicine, Preventing Misdiagnosis of Women.  1997.