Diagnostic Uncertainty vs. Unwarranted Certainty: which is worse for patients?

by Carolyn Thomas     ♥    @HeartSisters 

The Emergency physician who misdiagnosed my heart attack displayed not even a whiff of uncertainty while delivering that misdiagnosis.  “YOU” – he declared confidently – “are in the right demographic for acid reflux!”  (without any gastrointestinal diagnostic tests). He sent me home that day with instructions to ask my family doctor to prescribe antacid drugs for my symptoms (central chest pain, nausea, sweating and pain down my left arm).  I now suspect that, if only that confident doc would have bothered to Google my symptoms, both he and Dr. Google would have landed on the same search result:  myocardial infarction (heart attack).

But in fact, he seemed remarkably certain despite being remarkably wrong.   . Continue reading “Diagnostic Uncertainty vs. Unwarranted Certainty: which is worse for patients?”

Women’s heart attacks (still!) more likely misdiagnosed than men’s

by Carolyn Thomas     @HeartSisters   

My interest in women’s misdiagnosed heart attacks began after my own misdiagnosed heart attack. Despite textbook cardiac symptoms of central chest pain, nausea, profuse sweating and pain down my left arm, I was confidently told: “You’re in the right demographic for acid reflux!” – and sent home from the Emergency Department. 

I know that, had I been appropriately diagnosed and treated on that fateful day, I’d have little interest in this topic. But I wasn’t. So I do.     .         .    Continue reading “Women’s heart attacks (still!) more likely misdiagnosed than men’s”

“The doctors want my symptoms but not my stories”

by Carolyn Thomas     @HeartSisters

Marilyn Gardner, in her 2014 book called “Between Worlds: Essays on Culture and Belonging“) wrote about a compelling conversation she once had:

Yet our physicians aren’t trained to embrace our stories, but instead to ask right away, “What brings you here today?” to kick-start a brief Q&A that can most efficiently solve the diagnostic mystery sitting across from them.      .     .    Continue reading ““The doctors want my symptoms but not my stories””

Signals, noise, context – and your doctor’s brain

    Emergency physician, professor, author, and patient safety expert Dr. Pat Croskerry

by Carolyn Thomas      @HeartSisters 

Emergency physician Dr. Pat Croskerry tells the story of the day he misdiagnosed a patient who was experiencing unstable anginachest pain caused by coronary artery disease, and often a warning sign of oncoming heart attack. But this is what he’d said before sending that patient home:

“I’m not at all worried about your chest pain. You probably overexerted yourself and strained a muscle. My suspicion that this is coming from your heart is about zero.”

In a later interview with Dr. Jerome Groopman (author of a book I love called How Doctors Think), Dr. Croskerry explained how easily that misdiagnosis happened: Continue reading “Signals, noise, context – and your doctor’s brain”

When you know more than your doctors about your diagnosis

by Carolyn Thomas   @HeartSisters

One of my blog readers needlessly suffered debilitating cardiac symptoms for a number of years before she was finally correctly diagnosed (thanks to a second opinion) with coronary microvascular disease (MVD). During those years, she’d read everything she could get her hands on in a desperate effort to solve this mystery. But when she asked her own physician if MVD might be the culprit, he dismissed this diagnostic possibility, adding that he “didn’t believe” in coronary microvascular disease.

Didn’t believe in it?!

Please note, darling readers, that we’re not talking about the Tooth Fairy here.

We’re talking about a woman living with a cardiac condition that’s been well-studied (as in, peer-reviewed studies done by respected heart researchers and published in actual real-life medical journals).

Continue reading “When you know more than your doctors about your diagnosis”