Diagnostic Errors in Radiology reach 30-75%!
Let’s face it, everyone makes mistakes. Regrettably, when we visit out doctor for an injury and accurate diagnosis we tend to forget this and give their judgment undo credibility. A typical scenario involves a person suffering from shin pain that has recently taken up running. During the visit to the doctor X-rays are ordered and the patient is told “it shows nothing” you must just have shin splints. The patient leaves believing they do not have a stress fracture because the doctor appeared to have ruled this out by taking X-rays and the Radiologist who read the films said nothing was wrong with the bone. All of this assumes that
- An X-ray is the correct diagnostic tool for diagnosing stress fractures (it is not)
- The Radiologist read the X-ray correctly (this may not be true)
Radiologist is one of the medical specialties most liable to claims of medical negligence. It was reported by the World Journal of Radiology in 2010 that errors arise from poor technique, failure of perception, lack of knowledge and misjudgments. The two most common types of “misses” are missed fractures and missed diagnosis of cancer.
The is estimated that the average error rate among Radiologists is around 30% (THESE ARE KNOWN REPORTED ERRORS). In fact in emergency room studies the error rate is significantly higher. Failure to identify fractures in emergency rooms accounts for 75% of ALL missed diagnosis with the shoulder girdle and feet being the region’s most often missed.
Obviously, Radiologist’s are not intending to misdiagnose and hurt patients. Nevertheless it is still occurring especially in the Orthopedic setting. The conclusion of the researchers is astounding! They state ” the system should change to allow patients to be seen by better trained doctors”!
How does the patient know if a doctor is better trained? Has more common sense? Is not burned out and apathetic? I would suggest being proactive and being a detective before you go for a visit to your doctor. Here are the steps on how to be a detective and stop the injury “crime”
- Research your condition by goggling the anatomical location of your pain. Use websites that are well written, contain good content and make sense. Obviously if your foot hurts you do not have “tennis elbow”. Do like a good detective would and start with the usual suspects.
- Narrow down the diagnosis by eliminating unusual or rare conditions. The likelihood that you have something unusual or rare is…….unlikely.
- Once you are left with the top 3 conditions that you most likely have see how each one of them might be eliminated as a diagnosis. For example; a stress fracture will not typically be seen on X-ray. An MRI is the gold standard test to diagnose this. Imagine you have heel pain and go to your doctor. The 3 likely diagnosis are Heel Spur, Plantar Fasciitis and Stress Fracture. MRI will show and differentiate all of these helping a doctor come to a proper diagnosis and formulating an effective treatment strategy. If they only took an X-ray it would give you a false sense of well being if it did not show a fracture…..but X-rays don’t typically show stress fractures!
- Pressure your doctor to do the correct tests and help you to eliminate “suspects”. Let’s say they don’t want to order the MRI….are there other ways of eliminating stress fractures? There sure are…let’s look at how we did it just earlier today.
The patient presented with a 8 week history of left foot pain. When asked, she had been to her doctor who had taken 3 sets of X-rays all of which were negative for fracture. This gave the patient and the doctor a false sense of security resulting in him telling her it was OK to run. As she began running the familiar pain came back in the exact location of her left foot (navicular bone……one of the most common stress fracture sites and most commonly missed by radiologists!).
After questioning her thoroughly she said something that most runners with stress fractures say. “It does not hurt when I run but hurts after”. This was our first clue to diagnosis. Next we had her perform the single leg hop test. She said that it did not hurt (maybe had we made her jump the equivalent of 4 miles it would have). Next we palpated the area of pain…..OUCH!!! She did not like pressure on that spot. Next we performed a pulsed ultrasound exam which caused pain in the bone (the patient should not feel any sensation especially not pain).
When you add up all of the evidence against this patients “suspect” you are left unequivocally with Bone Stress Injury to the Left Navicular as the only diagnosis.
The patient was instructed on where her Navicular bone was on the healing continuum and how to manage her injury from here without our help. She was given a home program and is expected to be able to pace a friend in an upcoming 50 mile Ultra Marathon within 3 weeks.
Need an appointment? You can email Dr. Runco at Drrunco@sdri.net
What if I live far away? No worries you can schedule a phone consultation. Email firstname.lastname@example.org and you will be sent all the necessary info. Phone consultations are 4237 and come with written treatment plans and any necessary video taped tutorials relevant to fixing your condition.