ISLAMABAD, Jan 16 (Online): Hundreds of thousands of U.S. patients are harmed or die each year because of diagnostic errors. Women and minorities are up to 30% more likely to be misdiagnosed than white men.<\/p>\n
As a Black woman, Charity Watkins is among two of the groups most likely to experience medical misdiagnoses.
\nCharity Watkins sensed something was deeply wrong when she experienced exhaustion after her daughter was born.
\nAt times, Watkins, then 30, had to stop on the stairway to catch her breath. Her obstetrician said postpartum depression likely caused the weakness and fatigue. When Watkins, who is Black, complained of a cough, her doctor blamed the flu.
\nAbout eight weeks after delivery, Watkins thought she was having a heart attack, and her husband took her to the emergency room. After a 5\u00bd-hour wait in a North Carolina hospital, she returned home to nurse her baby without seeing a doctor.<\/p>\n
Charity Watkins holds her daughter after giving birth.Kate Medley for KFF Health News
\nWhen a physician finally examined Watkins three days later, he immediately noticed her legs and stomach were swollen, a sign that her body was retaining fluid. After a chest X-ray, the doctor diagnosed her with heart failure, a serious condition in which the heart becomes too weak to adequately pump oxygen-rich blood to organs throughout the body. Watkins spent two weeks in intensive care.
\nShe said a cardiologist later told her, \u201cWe almost lost you.\u201d<\/p>\n
In a study published Jan. 8 in JAMA Internal Medicine, researchers found that nearly 1 in 4 hospital patients who died or were transferred to intensive care had experienced a diagnostic error. Nearly 18% of misdiagnosed patients were harmed or died.
\nIn all, an estimated 795,000 patients a year die or are permanently disabled because of misdiagnosis, according to a study published in July in the BMJ Quality & Safety periodical.
\nSome patients are at higher risk than others.<\/p>\n
Women and racial and ethnic minorities are 20% to 30% more likely than white men to experience a misdiagnosis, said Dr. David Newman-Toker, a professor of neurology at Johns Hopkins School of Medicine and the lead author of the BMJ study. \u201cThat\u2019s significant and inexcusable,\u201d he said.
\nResearchers call misdiagnosis an urgent public health problem. The study found that rates of misdiagnosis range from 1.5% of heart attacks to 17.5% of strokes and 22.5% of lung cancers.
\nWeakening of the heart muscle \u2014 which led to Watkins\u2019 heart failure \u2014 is the most common cause of maternal death one week to one year after delivery, and is more common among Black women.<\/p>\n
Heart failure \u201cshould have been No. 1 on the list of possible causes\u201d for Watkins\u2019 symptoms, said Dr. Ronald Wyatt, chief science and chief medical officer at the Society to Improve Diagnosis in Medicine, a nonprofit research and advocacy group.
\nMaternal mortality for Black mothers has increased dramatically in recent years. The United States has the highest maternal mortality rate among developed countries. According to the Centers for Disease Control and Prevention, non-Hispanic Black mothers are 2.6 times as likely to die as non-Hispanic white moms. More than half of these deaths take place within a year after delivery.<\/p>\n
Research shows that Black women with childbirth-related heart failure are typically diagnosed later than white women, said Dr. Jennifer Lewey, co-director of the pregnancy and heart disease program at Penn Medicine. That can allow patients to further deteriorate, making Black women less likely to fully recover and more likely to suffer from weakened hearts for the rest of their lives.
\nWatkins said the diagnosis changed her life. Doctors advised her \u201cnot to have another baby, or I might need a heart transplant,\u201d she said. Being deprived of the chance to have another child, she said, \u201cwas devastating.\u201d
\nRacial and gender disparities are widespread.<\/p>\n
Women and minority patients suffering from heart attacks are more likely than others to be discharged without diagnosis or treatment.
\nBlack people with depression are more likely than others to be misdiagnosed with schizophrenia.
\nMinorities are less likely than whites to be diagnosed early with dementia, depriving them of the opportunities to receive treatments that work best in the early stages of the disease.
\nMisdiagnosis isn\u2019t new. Doctors have used autopsy studies to estimate the percentage of patients who died with undiagnosed diseases for more than a century. Although those studies show some improvement over time, life-threatening mistakes remain all too common, despite an array of sophisticated diagnostic tools, said Dr. Hardeep Singh, a professor at Baylor College of Medicine who studies ways to improve diagnosis.<\/p>\n
\u201cThe vast majority of diagnoses can be made by getting to know the patient\u2019s story really well, asking follow-up questions, examining the patient, and ordering basic tests,\u201d said Singh, who is also a researcher at Houston\u2019s Michael E. DeBakey VA Medical Center. When talking to people who\u2019ve been misdiagnosed, \u201cone of the things we hear over and over is, \u2018The doctor didn\u2019t listen to me.\u2019\u201d
\nRacial disparities in misdiagnosis are sometimes explained by noting that minority patients are less likely to be insured than white patients and often lack access to high-quality hospitals. But the picture is more complicated, said Dr. Monika Goyal, an emergency physician at Children\u2019s National Hospital in Washington, D.C., who has documented racial bias in children\u2019s health care.
\nIn a 2020 study, Goyal and her colleagues found that Black kids with appendicitis were less likely than their white peers to be correctly diagnosed, even when both groups of patients visited the same hospital.<\/p>\n
Although few doctors deliberately discriminate against women or minorities, Goyal said, many are biased without realizing it.
\n\u201cRacial bias is baked into our culture,\u201d Goyal said. \u201cIt\u2019s important for all of us to start recognizing that.\u201d
\nDemanding schedules, which prevent doctors from spending as much time with patients as they\u2019d like, can contribute to diagnostic errors, said Karen Lutfey Spencer, a professor of health and behavioral sciences at the University of Colorado-Denver. \u201cDoctors are more likely to make biased decisions when they are busy and overworked,\u201d Spencer said. \u201cThere are some really smart, well-intentioned providers who are getting chewed up in a system that\u2019s very unforgiving.\u201d<\/p>\n
Doctors make better treatment decisions when they\u2019re more confident of a diagnosis, Spencer said.
\nIn an experiment, researchers asked doctors to view videos of actors pretending to be patients with heart disease or depression, make a diagnosis, and recommend follow-up actions. Doctors felt far more certain diagnosing white men than Black patients or younger women.
\n\u201cIf they were less certain, they were less likely to take action, such as ordering tests,\u201d Spencer said. \u201cIf they were less certain, they might just wait to prescribe treatment.\u201d
\nIt\u2019s easy to see why doctors are more confident when diagnosing white men, Spencer said. For more than a century, medical textbooks have illustrated diseases with stereotypical images of white men. Only 4.5% of images in general medical textbooks feature patients with dark skin.<\/p>\n
That may help explain why patients with darker complexions are less likely to receive a timely diagnosis with conditions that affect the skin, from cancer to Lyme disease, which causes a red or pink rash in the earliest stage of infection. Black patients with Lyme disease are more likely to be diagnosed with more advanced disease, which can cause arthritis and damage the heart. Black people with melanoma are about three times as likely as whites to die within five years.
\nThe Covid pandemic helped raise awareness that pulse oximeters \u2014 the fingertip devices used to measure a patient\u2019s pulse and oxygen levels \u2014 are less accurate for people with dark skin. The devices work by shining light through the skin; their failures have delayed critical care for many Black patients.<\/p>\n
Seven years after her misdiagnosis, Watkins is an assistant professor of social work at North Carolina Central University in Durham, where she studies the psychosocial effects experienced by Black mothers who survive severe childbirth complications.
\n\u201cSharing my story is part of my healing,\u201d said Watkins, who speaks to medical groups to help doctors improve their care. \u201cIt has helped me reclaim power in my life, just to be able to help others.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"
ISLAMABAD, Jan 16 (Online): Hundreds of thousands of U.S. patients are harmed or die each year because of diagnostic errors. Women and minorities are up to 30% more likely to be misdiagnosed than white men. As a Black woman, Charity Watkins is among two of […]<\/p>\n
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