Choosing a Physician

An important factor in getting properly diagnosed involves not only the quality of your physician but the relationship that you have with her or him. Here are some warning flags:

1) Your physician doesn’t listen well, immediately discounts your concerns, or only focuses on a narrow area of your health and/or your body.

2) Your physician is not inclined to take the time to explain to you the particularities of what s/he feels is your medical condition. This reluctance is not infrequently explained by the claim that these matters are “technical.”

3) Rigid thinking, arrogance or excessive self-assuredness are very bad signs. If your physician seems to see everything in black and white, will not question his or her own opinions or the results of the tests he orders, look for someone else. Every physician should welcome a second opinion.

4) If your physician does make a mistake, s/he should be willing to admit it. In his book Second Opinions, Jerome Groopman writes: “… most litigation grows not out of honest errors or even frank malpractice but from unresolved anger and poor communication. Physicians are not used to admitting when they are wrong and plainly stating to the patient and family that an error was made, a lab test overlooked, a finding missed on a physical exam, or an incorrect drug prescribed” (p.89). This is corroborated by work done by Albert Wu, and published in the Journal of Internal Medicine in 1997. Wu summarizes that article as follows: “We came down very strongly with the position that physicians are obligated to disclose errors that harm patients to patients and/or their families, largely because the patient stands to benefit from it. While there are potentially some risks or downsides for the physician, the doctor-patient relationship can also, paradoxically, improve sometimes with these discussions.”

Survey Shows Doctors Don't Always Disclose Errors

A survey of more than 2,600 surgeons and medical specialist, published in the Archives of Internal Medicine, reveals wide variations in doctor's willingness to disclose errors and present details to their patients.

When the error was obvious, like an improperly written prescription that led to an overdose, 81 percent of doctors said they would definitely disclose the error to a patient. But when presented with an error less apparent, only 50 percent thought it was worth mentioning. One example was a blood chemistry reading that had been overlooked. If it had been noticed, a serious complication would have been prevented.

According to a subsequent article in The New York Times, surgeons were more likely than other medical specialists to believe that an error would result in a lawsuit, but they were also more likely to report that they would definitely disclose an error.

At the same time, surgeons said that they would disclose less information than medical specialists, and they were less inclined to use the word ''error.'' Over all, 56 percent of doctors would mention the problem, but only 42 percent would disclose that the problem had been caused by an error.

False Positives Discourage Prostate Screening Behavior

Research published in Cancer Epidemiology Biomarkers & Prevention showed that patients who had experienced a false positive cancer screening result were less likely to return for prostate cancer screening in the following screening trial year. Click on the link above to read the full journal article.

Why Doctors Are Afraid to Be the Patient

Time magazine reporters interviewed doctors to find out what they know about our health-care system and why it frightens them so much when they find themselves in the role of the patient.

"It requires almost a stroke of luck to enter a U.S. hospital and receive precisely the right treatment," according to the article's authors. "A landmark Rand Corp. study published in 2003 found that adults in the U.S. received, on average, just 54.9% of recommended care for their conditions."

For the full story, download the attached article.

False Info About False Positives for Colon Cancer

The results of a recent study may change the way you're asked to prepare for a fecal occult blood test (FOBT). Researchers from Indiana University Medical Center found that the regular use of aspirin or NSAID's (non-steroidal anti-inflammatory drugs, like ibuprofen) does not cause false positives on fecal occult blood tests. (Please click on the headline above to link to the full story.)

Just How Prevalent Are False Positives?

According to an article entitled “The Economic Impact of False-Positive Cancer Screens,” published in Cancer Epidemiology Biomarkers & Prevention in December 2004, of “1,087 prostate, lung, colorectal, and ovarian cancer screening trial participants enrolled in a large managed care organization ... 43% of the study sample incurred at least one false-positive cancer screen.”

This is not to say that periodic cancer scans should not be performed. On the contrary, they are essential to the early detection of cancer. However, the danger arises when a physician insists on a definitive course of action involving potentially dangerous medication, unnecessary and harmful treatments, or surgery on the basis of a single test without alerting the patient to the potential for a false positive.

The False-Positive "Necklace"

A woman with papillary thyroid carcinoma treated with surgery and postoperative 131-I returned four years later for a whole-body survey. The imaging results initially suggested disease recurrence but were later found to be false positive and due to 131-I uptake in a necklace that had been contaminated by the patient’s saliva. According to doctors at the University of Washington in Seattle, where this occured, this case stresses the importance of having the patient remove all jewelry before undergoing a radioiodine survey.

Early Detection of Lung Cancer

Lung cancer kills more people worldwide than any other cancer. However, according to a report published in The Journal of Best Clinical Practices for Today's Physician, no available lung cancer screening protocol has proven sufficiently robust, safe, and cost effective to warrant a recommendation for population-based screening. The U.S. Preventive Services Task Force stated that although it found "fair evidence that screening with low-dose computerized tomography, chest x-ray, or sputum cytology can detect lung cancer at an earlier stage" than it would be detected without screening, the group also found "poor evidence that any screening strategy for lung cancer decreases mortality."

Furthermore, the risks inherent in the high number of false-positive test results that may occur from the use of these screening tools are cause for concern. These risks include the need for invasive diagnostic procedures to characterize suspicious nodules as benign or malignant and the potential anxiety caused by a false-positive result. Thus, although low-dose spiral CT offers a proven method for detecting small (less than 1 cm) lung tumors that are at an early, highly resectable stage, the challenge lies in developing diagnostic algorithms that minimize the number of false-positive results and limit the number of patients who undergo biopsy without missing treatable cancers.