One morning last June, my husband, Joel, sat down with the newspaper and discovered he couldn't drink his coffee without it dribbling out the corner of his mouth. He looked in the mirror and the right side of his face was drooping, like a one-sided frowning clown, and his right eye was frozen into an unblinking squint. This was especially alarming, because he's been legally blind in his left eye since birth. We drove to the doctor. In the parking lot, Joel, clearly disoriented, tried to climb out of the car before it had stopped.
As a reporter, I have been listening to Canadians' medical stories for years, from the heroic to the horrible. But this was the way I learned first-hand how faulty doctors' diagnoses can be.
Joel had seen his family doctor the week before, having woken up one day covered in round, bull's-eye-like splotches and with a shivering case of the flu. He could barely stay awake for three hours at the time. As patients do these days, we went online: He was just home from renovating our cottage in Nova Scotia, so maybe it was a cold-water rash from swimming in the ocean (a preposterous case of what doctors disparagingly call “cyberchondria”).
However, a physician friend, after hearing about an unusual “spider” bite on Joel's stomach, suggested Lyme disease – a potentially serious, relatively rare illness caused by deer-tick bites. He had seen cases before.
But Joel's family doctor had not, and he had not been convinced: He had reluctantly ordered the blood test for Lyme disease, given him some oral antibiotics and sent him home. The morning of the facial droop, his reaction was no more urgent: He said Joel had Bell's palsy, a fairly common and benign condition that usually appears for no reason and goes away on its own. We could go to the emergency room, but his attitude was that we were overreacting.
At emergency, we saw a polite, professional young doctor. We asked him about Lyme disease. No, he said. It was definitely Bell's palsy. Joel should not worry, and return to work – even though he could no longer speak clearly and could barely see.
The doctor never asked what Joel did for a living: He's a church minister.
But why had he tried to climb out of the car? That was just stress. When we pressed, the doctor reluctantly referred us to a specialist, but the appointment would be more than six weeks later.
This is where doubt sets in, as patients often find – the fear that you are making a fuss over nothing. But finally, our doctor friend told a colleague, and the infectious-disease clinic called the next day.
In the exam room, the doctor patiently listened, interrupting only to clarify the timeline. In less than 10 minutes, Joel was diagnosed with Lyme disease, and by the time we left the hospital, he'd had a spinal tap to ensure that the bacteria had not entered his nervous system, a round of intravenous antibiotics pumped directly into his heart, a prescription for injections from a home-care nurse for four weeks and a referral to a cardiologist to check his heart for infection.
Joel was lucky to be diagnosed so quickly, he was told later. (We knew we were lucky to know a doctor to advocate for us.) The longer the delay, the harder the infection is to treat, raising the risk of neurological side effects, arthritis or heart complications.
An overloaded system
How could this misdiagnosis have happened – and, what's more, persisted even as counter-evidence piled up? It not as unusual as patients – and doctors – would hope: Statistics show that 10 to 15 per cent of patients are misdiagnosed; the number is likely higher, since many medical errors are never discovered.
A 2001 study estimated that one in five mistakes occur because the system fails – a report is lost or a test is inaccurate, as in the case of nine Newfoundland women who launched a suit against the province this week, alleging that sloppy testing misdiagnosed them with severe breast cancer and that they unnecessarily underwent double mastectomies.
But that means roughly 80 per cent of mistakes are physician error. Sometimes the flu is meningitis; what presents as a kidney stone is really acute appendicitis. Even the best doctors blunder, as the recent confusion around Sidney Crosby's injury demonstrates: Was it a concussion or a broken neck or soft tissue damage, a combination of all three? It's still not clear.