Dr. Shapira's Chicago Headache Blog

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Wednesday, September 29, 2010

One in Six patients perceive that wrong diagnosis have been made.

An interesting study from the Archives of Internal Medicine (abstract below)reports that 1one in six patients percieve that their doctors have made wrong diagnosis. The study reported "Patients with chronic back pain, higher educational attainment, and poor physical health were at increased odds of perceiving mistakes".

This leads to two questions, were there actual mistakes in diagnosis and treatment or was this just a patient perception. Is it possible that there were multiple diagnosis and they were not yet all discovered?

I frequently see Headache and Migraine patients with numerous diagnosis and medications. I treat these patients with neuromuscular dentistry and their pain is rapidly eliminated. This does not mean that the previous diagnosis were wrong but rather treatment was ineffective. Typically patients with TMJ problems that lead to headaches have seen a minimal of six doctors prior to seeing the dentist, sometimes dozens of physicians. That is why TMJ Disorders are called "THE GREAT IMPOSTER" SEE http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor to read "SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER"

Elimination of the headaches does not necessarily mean that other diagnosis were wrong but rather they were not the true cause of the pain. The expression "you can't see the forest for the trees" describes this type of problem. Relieving the headaches and Neuromuscular symptoms makes the patients feel great but frequently remaining symptoms not related to the Trigeminal Nervous system can also be discovered.

Dr Mercola of Mercola.com stated "One in Six Patients Report Getting Wrong Diagnosis
With each survey, study, and statistical review, the answer remains the same: Patients beware, because conventional medicine may inadvertently lead to you or your family's premature demise." It is important to note that this study was talking about patient perceptions about their diagnosis not actual diagnosis.

Solving chronic pain problems is like peeling an onion, as you relieve one layer of the onion you come to the next. Different layers of the onion may need different practioners or treatment. Sometimes it is necessary to treat one problem before progress can be made in other problems.

I frequently see patients who also go to chiropracters or osteopaths for spine adjustments that relieve their headaches but the adjustments do not hold. Combining a diagnostic neuromuscular orthotic with the chiropractic treatment eliminates the trigeminal system problems but also allows the spine to stabilize. Neither treatment works as well alone as the two treatment work combined.

I once had a patient who had constant daily headaches that were completely relieved by a neuromuscular orthotic with the exception of a pain in the right occipital area. The patient stated that was the first pain when the problem started, but did not remember that until the rest of the pain was gone. I could not find any trigger points in the muscle to duplicate the pain but the patient said that he first experienced the pain while playing golf and taking a back swing. When we had him repeat that motion the trigger point became active and we could locate, inject and eliminate it with complete relief of years of pain. That was probably the original injury but would never have been found without first getting him off of medications that masked the pain, correcting occlusal problems (TMD not TMJ this patient had no TM Joint problems just neuromuscular problems)

This patient had had several cat scans and an MRI and was told he has Multiple Sclerosis due to an abnormal MRI and symptoms. He refused to return to the neurologist but I explained that the MRI changes were real. When he revisted a new neurologist the MRI was still abnormal but because there were no symptoms no diagnosis of MS was made. The neurologist did say it could be a problem in the future but for many years the pain did not return. This case is one where the symptoms plus the abnormal MRI combined were used for the diagnosis but taken seperately a very different outcome. If there had never been pain the MRI would not have been taken and the accidental discovery of a questionable area on the brain would not be seen"

The study mentioned patients with back pain. Radiographic imaging of a patient with back pain frequently shows abnormalities which the pain is the attributed to. Patient with these same abnormalities are walking around pain free for years but no imaging is ever done until the pain occurs. Finding pain and radiographic changes does not always imply cause and effect. Studies have shown that the bell curves of pain and bell curves of radigraphic changes are not the same. Some patients with terrible arthritis have no pain and some with miserable pain have little objective evidence of pain. When the pain is labeled frequently other causes of pain are no longer even considered. The diagnosis of arthritis is correct but is just not the cause of pain. Arch Intern Med. 2010 Sep 13;170(16):1480-7.

Patient perceptions of mistakes in ambulatory care.

Kistler CE, Walter LC, Mitchell CM, Sloane PD.
Division of Geriatrics, Department of Medicin, University of California-San Francisco, USA. umanohone@yahoo.com
Arch Intern Med. 2010 Sep 13;170(16):1487-9.
BACKGROUND: Little information exists about current patient perceptions of medical mistakes in ambulatory care within a diverse population. We aimed to learn about the perceptions of medical mistakes, what factors were associated with perceived mistakes, and whether the participants changed physicians because of these perceived mistakes.

METHODS: We conducted a cross-sectional survey at 7 primary care practices in North Carolina of English- or Spanish-speaking adults, aged 18 years and older, who saw a health care professional during 2008. Main outcome measures were 4 questions about patient perceptions of medical mistakes in the ambulatory care setting, including (1) overall experience with a medical mistake; type of mistake, such as a (2) diagnostic mistake or (3) treatment mistake, and its associated harm; and (4) effect of this mistake on changing physicians.

RESULTS: Of 1697 participants, 265 (15.6%) responded that a physician had made a mistake, 227 (13.4%) reported a wrong diagnosis, 212 (12.5%) reported a wrong treatment, and 239 (14.1%) reported having changed physicians because of a mistake. Participants perceived mistakes and harm in both diagnostic care and medical treatment. Patients with chronic back pain, higher educational attainment, and poor physical health were at increased odds of perceiving mistakes, whereas African American patients were less likely to perceive mistakes.

CONCLUSIONS: Patients perceived mistakes in their diagnostic and treatment care in the ambulatory setting. These perceptions had a concrete effect on the physician-patient relationship, often leading patients to seek another health care professional.

PMID: 20837835 [PubMed - in process]

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posted by Dr Shapira at 6:54 AM

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