The Emergency Room is a busy place. There are lots of opportunities for things to fall through the cracks. A study published in July 2023 showed that the hectic pace led to hundreds of thousands of incorrect diagnoses each year.
As you might expect some diagnoses were easier to miss than others. Stroke was at the top of the list. About 17.5 percent of patients with a stroke were not immediately diagnosed. For example, a patient might show up with a bad headache. The given diagnosis might be migraine. However, the real problem is stroke.
One of the things we were taught was that if a person comes in saying that they are having the worst headache of their life, be on the alert. If the headache is that severe, something more than migraine needs to be thought about.
There are other symptoms that might suggest a stroke but appear to be something else. These include dizziness. They include vertigo. They include something suggesting inner ear disease. A full blown stroke is easy to diagnose. However, things are not always that obvious.
Sepsis was second. Sepsis is a blood borne infection that might only cause mild symptoms at first. When the symptoms get bad enough to make the diagnosis obvious, it is sometimes too late to treat it. We have seen women die after getting sepsis from a miscarriage.
Pneumonia was third. I once had a case of pneumonia. I had no cough. I had no fever. All I had was some chest pain. I made the diagnosis myself when I noticed some increased shortness of breath climbing hills or stairs.
Blood clots in veins were in fourth place. These become a real problem if they get dislodged and travel to the lungs. This is called a pulmonary embolus. A few weeks ago, I wrote about how often they are misdiagnosed as heart failure.
Lung cancer was in fourth place. Lung cancer tends to not show up on plain chest X-ray until it is pretty advanced. Therefore, even if a chest X-ray is done for a cough, it might miss the diagnosis.
The article suggested that patients should do some things to help make the chance of an error decrease. The first of these is knowing the names of all your doctors. They may have information that helps the emergency room focus in on the problem.
The second is related to your electronic record. Being able to access that in the emergency room is helpful to the treating physicians.
The third is to make sure your medical history and medication history are up to date. A few months ago, I wrote about the importance of keeping all that information updated on your iPhone health app.
The fourth is to create an electronic notebook in the message section of your phone. That can include test results (if they are not in your electronic health record). It can also include conversations with providers. You can actually show it to the provider to make sure you have recorded it correctly at the time of the conversation.
The fifth is knowing how to alert your health care team to changes in your condition.
The sixth is asking questions about tests that are ordered. You should know why it’s needed. You should know who is scheduling it. You should know the date it is scheduled. You should know what to do to prepare for the test.
Medicine has always been complicated. Over the years, it has become more complicated. That is especially true from the standpoint of new treatments and new diagnostic tests. Patients need to take an active role in making sure that a busy emergency room environment does not allow things to get sidetracked.