As each year passes and thousands of deaths caused by misdiagnosis continue in Australia, we begin to question if doctors are doing enough to eradicate these preventable deaths?
It was early in the day when Louise received a phone call from her brother-in-law informing her that her father had passed away from a cardiac arrest.
“Why would you even joke about this,” she yelled down the line assuming that it was impossible that her 55-year-old father was dead. “It took a long time for my brother-in-law to convince me,” she says. “I had only seen my dad a few hours earlier and he looked perfectly healthy, I could not believe that he was gone.” Resting her face in her hands, Louise began to sob. Although her father passed away 29 years ago the memories of it are still so clear “it feels like it happened yesterday”.
The autopsy report would later reveal that Louise’s father had a blockage in his heart that was missed when he was admitted to hospital months earlier complaining of heart issues. Instead he was diagnosed with pericarditis and no angiogram was conducted. “If they did an angiogram he could still be here today,” Louise told me with tears still running down her cheek. “But the doctor told him he was as fit as a 20-year-old.”
Louise’s story is just one of many in Australia with estimates putting the number of diagnostic errors in Australia at 140,000 cases a year, with 21,000 cases of serious harm and between 2000 and 4000 deaths. Although potentially avoidable deaths have minimised since Louise’s father died in 1990 these figures are still considerably high.
Although deaths due to misdiagnosis are in there thousands annually not one health-care organisation in Australia is measuring the scale of diagnostic error in its patients. “Lots of stats are being collected but no one is doing anything with them,” says Medical Error Action Group founder, Lorraine Long. “The same mistakes repeat over and over and the deaths continue.”
In 1994, Lorraine’s mum was rushed to hospital after an asthma attack and died only 14 hours later. Her unfortunate fate was not due to the asthma as one may assume but due to a misdiagnosis of her deteriorating condition. Compounding the shock of her mother’s sudden death was the fact that it was unnecessary and could have been prevented. Lorraine has always felt that the doctors were somewhat responsible.
“Is it reasonable to blame the doctor if a patient dies from misdiagnosis?” I asked.
“Yes,” she exclaimed. “Each doctor is 100 per cent fully responsible and accountable for the rendered treatment of their patient. Same with nurses rendering care.”
“Could there have been other variables that led to a misdiagnosis?” I asked cautiously.
“I have heard the system failure response for 25 years, this is off-loading responsibility to the ether,” she says. “How come these system failures have not been remedied then? There would be less preventable deaths if they had.”
Doctors are attempting to remedy these system failures though with multiple preventative measures. These include allocating time to effectively communicate with patients, collaborating in person with other professionals to interpret difficult diagnosis, and follow-up and tracking of diagnostic information over time. However, “450,000 preventable and unnecessary deaths 25 years later indicate strategies are not working,” Lorraine says.
Anthony Bianco, a survivor of a late stage rare cancer does not believe doctors are to blame for a patient’s misdiagnosis. “There are a number of factors regarding misdiagnosis,” he says. “It is not just one thing.”
Anthony was only 21 when his doctors learned that he was likely going to die. It started with an intermittent dry cough and fever. Many years, many doctors and many drugs later the symptoms continued. Finally he had difficulty breathing and became severely lethargic. Then an X-ray showed that a tumour was growing at a scarily rapid rate, and the veins in his chest had been pushed out. “Everything changed when I first saw the slides,” Anthony says. “I remember the shades of black and white slowly appearing as each part of the x-ray made contact with the light. Then I saw the big cloud of white. A really big cloud of white. Smack bang in the middle of my chest. Big white clouds look nice in the blue sky, but not in a chest x-ray especially when the x- ray is yours.”
The tumour had grown to 11 centimetres wide and 15 centimetres high. A sample was taken and sent for testing. All of this blissful student existence suddenly changed with the utterance of a few words, “You have cancer”. He had primary mediastinal nonseminatous germ cell tumour, a cancer with a one in 10 million chance of getting. Anthony sat there alone in the doctor’s office stunned.
Only given one month to live Anthony was “extremely lucky to survive” but why was he and many others who have unfortunately passed away been misdiagnosed?
With more than 12,000 diseases according to the World Health Organisation doctors would not be aware of health issues that are extremely rare. In Anthony’s case his primary mediastinal nonseminatous germ cell tumour was difficult to diagnose as there is a one in 10 million chance of getting it. “Most doctors would have never come across something like this before,” Anthony says.
The commonness of symptoms also plays a role in misdiagnosis. There can be scenarios where serious conditions can appear as relatively normal illnesses such as the common cold. For Anthony, his symptoms did not appear sinister as he only had an occasional dry cough and fever. It was only when a tumour grew rapidly that doctors diagnosed him with the extremely rare cancer.
Another issue that also arises is that the doctor deems a patient too young to have any deadly illnesses. With Anthony his doctors did not register the cancer for numerous years due to him being only in his early 20s. “For young people, I think there is a perception that less things go wrong with their health,” Anthony says. “But if a young person says they are feeling sick they are sick.”
“I just got through this by the skin of my teeth,” Anthony reflects. “Other people that are misdiagnosed are not so lucky.”
*Some names have been changed to protect the privacy of individuals.
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