7 million misdiagnosed per year in US ER's says govt report

jimmyjames8

jimmyjames8

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tell me about it. my wife had to go the other weekend for either a giant kidney stone that needed surgery, or a lesion on her kidney, or a lesion on her spine, or maybe just bone cancer in her spine, but also maybe something wrong with her small intestine being twisted, or just a blood flow problem. they don't know, but it was a lot of conflicting diagnoses in the span of 1 day. it was so serious that they made her get to a hospital for emergency imaging so they could give her a couple pills and sent her home at midnight.
 
More likely 130 million visits to the ER. Unless they're counting urgent care visits as well. Even then, it's probably visits rather than 130 unique individuals.

But if a person goes to the ER and identifies one way, and then goes again and identifies another, is that just two visits or two different people?

Of course, there's always the fact that the report is coming from CNN so none of it is accurate.
 
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And this is my favorite. 685 people killed per day by medical malpractice in this country.
 
jimmyjames8 said:
www.hopkinsmedicine.org

Newsroom

Follow the Johns Hopkins Medicine newsroom for the latest updates in medicine, scientific discovery, and next generation medical education, expert sources, and media contact information.
www.hopkinsmedicine.org www.hopkinsmedicine.org

And this is my favorite. 685 people killed per day by medical malpractice in this country.
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But my guns are the real problem
 
BlackGun said:
As a patient I first went to an emergency room at 16 I believe. 5 times my entire life. The misdiagnosis part does not surprise me at all.
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Been twice in 63 years that I can remember. Puking up blood after tonsillectomy (which was probably unnecessary) at age 6 and then during covid for a BAM infusion which was also probably unnecessary but as I always say, why go to the doctor if you arent going to do what they say. You pays your money and you takes your chances.
 
I've been to the ER multiple times in my life, mostly due to some form of injury.

On the few occasions where I went because I was sick, only once was I "misdiagnosed". They gave me Tylenol and sent me home with a diagnosis of "fever".

The next morning, the cause of the fever made itself evident and I ended up getting the antibiotics I needed for the infection in my leg.
 
JimB said:
Bout chopped off a thumb with a machete a few years ago, they diagnosed it correctly.
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Yeah, gotta give 'em some credit. ER's across this great Nation have accurately diagnosed my umpteen sewing-lesson lacerations and multiple broken bones.
 
Years ago my wife had excruciating abdominal pain and we went to the ER at Memorial. There was nobody in the ER other than staff that evening (slow night) and it took 4 hours to get seen by a doc. The doc was a Indian woman, and by Indian, I mean not a Native American. She would only speak with my wife, I didn't exist in the room. She told my wife that all she had was gas and to go home and it would resolve itself. 7 hours to get that diagnosis. On the way out, my wife said, it's not gas and to make the drive to Presbyterian. She was seen in a bit over an hour. Diagnosis was gall stones and it was infected, removal of the gall bladder needed immediately, meaning straight to surgery before it ruptured.

So she got the correct treatment, came home and all was well until I got the bill from Memorial. To say I was a bit angry with them may have been an understatement. I called the Accounting Dept. and told the drone on the other end I wasn't paying. The drone said they'd sue and I said to go ahead and try but first I wanted to speak with somebody in authority in that department. A moment later a person came on who identified themselves as the head of the accounting/collections. I told them what had transpired in their ER, the arrogant immigrant doctor, the misdiagnosis, the length of time it took to even get seen and then I told them how it got resolved at Presbyterian. I told them if they wanted to sue me for non-payment to try it, because I was going to counter sue for malpractice. It got quiet for a moment and I was transferred to another person identifying as a VP of something at Memorial. We had the same conversation and the person asked what would it take for this to be resolved. I said I wanted a registered letter on official letterhead from Memorial that all matters of billing related to this case were considered paid in full and if I ever got another letter from them asking for money, I would carry through on a malpractice suit and a computer error wouldn't be a good enough excuse on their part. Got the letter. Never heard from them again.
 
I took my wife to the ER 4 times in the last 26 years.
First time was when she broke her water with our son. Phone triage directed us to the ER as it was 11PM. My wife was only 1cm dilated but her blood pressure was really high. Short version, labor induced, son born at 9:15AM.
2nd time was emergency c section for our daughter. What a trip that was. All went well.
3rd, a bad intestinal infection. 103.5 fever. This was on father's day, the morning after my father died from colon cancer.
4th time. My wife called me at work saying she didn't feel well and heart rate was 220. I thought she was mistaken. Rushed home, only live 2 miles from work then. Off to the ER. Supraventricular tachycardia.

No bad experiences for any other these trips. 3 were Mass General in Boston. 1 was Lowell General.
 
Nonspecific or atypical symptoms were the strongest factor resulting in misdiagnosis, the study found.
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Cognitive bias and error are real.

Most docs are tuned in to ā€œtypicalā€ signs and symptoms.

If it doesnā€™t present in a way thatā€™s consistent with the actual diagnosis, itā€™s hard to convince yourself thatā€™s the actual diagnosisā€¦

The hard truth is that sometimes disease has to get worse before it can be accurately diagnosed

DrScaryGuy said:
my wife had to go the other weekend for either a giant kidney stone that needed surgery, or a lesion on her kidney, or a lesion on her spine, or maybe just bone cancer in her spine, but also maybe something wrong with her small intestine being twisted, or just a blood flow problem. they don't know, but it was a lot of conflicting diagnoses in the span of 1 day.
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This is a classic example of a presentation (back/abdominal pain Iā€™m assuming) that could literally be caused by a bunch of different organs and system. If it wasnā€™t something severe and obvious it could take a lot more testing to diagnose (ultrasound, CT, MRI, spinal tap etc) to diagnose. Combine this with a bunch of people going to the ER because they have bad gas and are just a few farts away from curing themselves makes it challenging
 
vp9c said:
Cognitive bias and error are real.

Most docs are tuned in to ā€œtypicalā€ signs and symptoms.

If it doesnā€™t present in a way thatā€™s consistent with the actual diagnosis, itā€™s hard to convince yourself thatā€™s the actual diagnosisā€¦

The hard truth is that sometimes disease has to get worse before it can be accurately diagnosed



This is a classic example of a presentation (back/abdominal pain Iā€™m assuming) that could literally be caused by a bunch of different organs and system. If it wasnā€™t something severe and obvious it could take a lot more testing to diagnose (ultrasound, CT, MRI, spinal tap etc) to diagnose. Combine this with a bunch of people going to the ER because they have bad gas and are just a few farts away from curing themselves makes it challenging
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In my wife's case, the presentation was severe abdominal pain and cramping. The ER doc at Memorial conducted no tests and only did a cursory physical exam that consisted of not much more than poking and prodding that caused even more pain. At Presbyterian, a quick blood test revealed an elevated white blood cell count, a sure sign of infection somewhere. They did one other test that revealed it was digestive in origin and an ultrasound showed the gall stone so well that a blind man could read it. The gall stone was the size of a golf ball and after surgery, the surgeon came out and showed it to me and commented that she only had hours prior to surgery before it would have ruptured and caused serious sepsis and all the bad things that happen with that. So I about lost my wife because of an arrogant immigrant doc. For as long as I lived in CLT after that, under no circumstances would I have allowed myself to go to the Memorial ER.
 
fishgutzy said:
I took my wife to the ER 4 times in the last 26 years.
First time was when she broke her water with our son. Phone triage directed us to the ER as it was 11PM. My wife was only 1cm dilated but her blood pressure was really high. Short version, labor induced, son born at 9:15AM.
2nd time was emergency c section for our daughter. What a trip that was. All went well.
3rd, a bad intestinal infection. 103.5 fever. This was on father's day, the morning after my father died from colon cancer.
4th time. My wife called me at work saying she didn't feel well and heart rate was 220. I thought she was mistaken. Rushed home, only live 2 miles from work then. Off to the ER. Supraventricular tachycardia.

No bad experiences for any other these trips. 3 were Mass General in Boston. 1 was Lowell General.
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Each of those are legit ED visits.

vp9c said:
Cognitive bias and error are real.

Most docs are tuned in to ā€œtypicalā€ signs and symptoms.

If it doesnā€™t present in a way thatā€™s consistent with the actual diagnosis, itā€™s hard to convince yourself thatā€™s the actual diagnosisā€¦

The hard truth is that sometimes disease has to get worse before it can be accurately diagnosed

This is a classic example of a presentation (back/abdominal pain Iā€™m assuming) that could literally be caused by a bunch of different organs and system. If it wasnā€™t something severe and obvious it could take a lot more testing to diagnose (ultrasound, CT, MRI, spinal tap etc) to diagnose. Combine this with a bunch of people going to the ER because they have bad gas and are just a few farts away from curing themselves makes it challenging
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Yep. EM docs are trained to save lives; if your life does not need saving, they work off a list of differential diagnoses and put a band aid on and tell you to see someone else (be it a PCP, a specialist, whatever).

I am not surprised about this news. I can see viral vs bacterial infections making a lot of those cases, diffuse abdominal pain, some of those cases of multiple symptoms and multiple causes.

Trauma is easy: broken bones, car wrecks, GSWs. Complex medical is hard.

Part of the problem is public expectation: they expect to go to the ED and be all better. That's not the job of the ED.
jimmyjames8 said:
www.hopkinsmedicine.org

Newsroom

Follow the Johns Hopkins Medicine newsroom for the latest updates in medicine, scientific discovery, and next generation medical education, expert sources, and media contact information.
www.hopkinsmedicine.org www.hopkinsmedicine.org

And this is my favorite. 685 people killed per day by medical malpractice in this country.
Click to expand...

Medical errors are, unfortunately, easy to make, and common. Medical malpractice is rarer. Some things like electronic charting have decreased much of those errors, especially med errors. But there's a LOOOOOONG way to go.
 
Dave951 said:
In my wife's case, the presentation was severe abdominal pain and cramping. The ER doc at Memorial conducted no tests and only did a cursory physical exam that consisted of not much more than poking and prodding that caused even more pain. At Presbyterian, a quick blood test revealed an elevated white blood cell count, a sure sign of infection somewhere. They did one other test that revealed it was digestive in origin and an ultrasound showed the gall stone so well that a blind man could read it. The gall stone was the size of a golf ball and after surgery, the surgeon came out and showed it to me and commented that she only had hours prior to surgery before it would have ruptured and caused serious sepsis and all the bad things that happen with that. So I about lost my wife because of an arrogant immigrant doc. For as long as I lived in CLT after that, under no circumstances would I have allowed myself to go to the Memorial ER.
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Good example of having to advocate for yourself or do something different if your needs arenā€™t being met. Glad you recognized there was more going on and sought more help and things worked out.
 
I've done the ER for extreme back pain. As @JimB stated, they have outstanding drugs on hand for this.

I've gone once for severe de-hydration. I was sick with flu. Wife went to her family gathering and left me home alone. I called her for six hours asking...and later begging her to come home. When she finally got home I was nearly dead. She thought I was just being a baby.

Other visits were for broken bones or bleeding from places you ain't supposed to bleed from.
 
Chdamn said:
ERā€™s are used as primary care by illegal aliens.

Cut that out and ERā€™s would slow down, docā€™s would be able to take more than 2 seconds with each patient and those bad numbers would decrease.
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Add in those on the dole. Used to work with a lady who was a recipient and had Medicaid. Off to the ER for every sniffle at the taxpayers expense.
 
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Chuckman said:
Part of the problem is public expectation: they expect to go to the ED and be all better. That's not the job of the ED.
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This. 100%. Too many people using ER as the Family Doc or <whatever> specialist.
 
Chdamn said:
ERā€™s are used as primary care by illegal aliens.

Cut that out and ERā€™s would slow down, docā€™s would be able to take more than 2 seconds with each patient and those bad numbers would decrease.
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Ironically, illegals generally and Hispanics/Latinos specifically are self pay: you should see the wad of cash they pull out.

Unfortunately with the EMTALA laws, there's no gate to stop people from using the ED who do not need the ED...illegals, people seeking primary care, medicare/medicaid, the indigent, whoever.
 
I dont have the patience to wait in an ER for 4 hrs for anything unless I was unconscious. I get pissed if I have to wait more than 5 mins at the GP when I arrive 15 mins early. After many years looking for a new GP. Covid broke mine. He aint the same Dr as when I started with him 5-6 years ago. Last time in a couple weeks ago he kept me waiting 45mins and then spent about 3 mins with me, called me a liar and walked out in a huff.
 
Chdamn said:
ERā€™s are used as primary care by illegal aliens.
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Yep, and add to that people looking to just get a pain med 'script, people who treat the ER like their family doctor, and people who have existing health issues (diabetes, COPD, etc.) that refuse to change their lifestyle habits. ER staff are overwhelmed and I can understand them just trying to get people out the door. Our healthcare system is broken and way too accessible IMO.
 
Chuckman said:
Each of those are legit ED visits.



Yep. EM docs are trained to save lives; if your life does not need saving, they work off a list of differential diagnoses and put a band aid on and tell you to see someone else (be it a PCP, a specialist, whatever).

I am not surprised about this news. I can see viral vs bacterial infections making a lot of those cases, diffuse abdominal pain, some of those cases of multiple symptoms and multiple causes.

Trauma is easy: broken bones, car wrecks, GSWs. Complex medical is hard.

Part of the problem is public expectation: they expect to go to the ED and be all better. That's not the job of the ED.


Medical errors are, unfortunately, easy to make, and common. Medical malpractice is rarer. Some things like electronic charting have decreased much of those errors, especially med errors. But there's a LOOOOOONG way to go.
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Public expectation is usually completely wrong with regards to the ER. The ER is designed for saving life.
 
Dave951 said:
Public expectation is usually completely wrong with regards to the ER. The ER is designed for saving life.
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The frustrating part of this is now everyone gets a patient satisfaction survey, and the hospital and ED will change policies and procedures to reflect that. We really don't even try to educate people anymore about the role of the ED vs urgent care vs primary care. Now we just take it up the you-know-what and let patient satisfaction surveys dictate how we work.
 
Railsplitter said:
Yep, and add to that people looking to just get a pain med 'script, people who treat the ER like their family doctor, and people who have existing health issues (diabetes, COPD, etc.) that refuse to change their lifestyle habits. ER staff are overwhelmed and I can understand them just trying to get people out the door. Our healthcare system is broken and way too accessible IMO.
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With state board of medicine changes, people are getting mightily pissed when they leave the ED with three opioid tabs instead of a 30 count. We've really cracked down on what and how much we can write for (re: pain meds).
 
Chuckman said:
With state board of medicine changes, people are getting mightily pissed when they leave the ED with three opioid tabs instead of a 30 count.
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I'm guessing that's why our ER now has signs everywhere stating that it's a felony to assault a healthcare worker. I really admire ER staff - ain't no way I could do that job.
 
Railsplitter said:
I'm guessing that's why our ER now has signs everywhere stating that it's a felony to assault a healthcare worker. I really admire ER staff - ain't no way I could do that job.
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I started working in the ED part time in 2003; FT, 2006. It used to not be a felony; in fact, we were often told "it's part of the job" and it happened with frequency. WTH?? No, it's not. More than a few times ED nurses wanted to press charges for being assaulted, only to be talked out of it by corporate (i.e., legal). Fortunately, that changed a few years ago and now staff are encouraged to press charges and there's a zero tolerance policy.

If they (non-urgent/emergent patients, leadership/management, legal/risk management, etc) could leave us alone to take care of 'real' ED patients, it would be a great job. But no.
 
Years ago, I said that Obozocare was designed to break the medical industry, which I think is true. Covid came along and made things a lot worse. Now, to me it seems that we have what is effectively a socialized medicine system with Cadillac pricing courtesy of this insurance racket (racket as in racketeering).
 
noway2 said:
Years ago, I said that Obozocare was designed to break the medical industry, which I think is true. Covid came along and made things a lot worse. Now, to me it seems that we have what is effectively a socialized medicine system with Cadillac pricing courtesy of this insurance racket (racket as in racketeering).
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Specific to the ED, I believe EMTALA was enacted under Reagan (1986). That single act was what precipitated the crush of all emergency departments, everywhere. The actual law does give an ED doc the right to say "you are not having an emergency, we're not treating you"; however, case law since has pretty much rendered that ability dead.
 
Chuckman said:
Specific to the ED, I believe EMTALA was enacted under Reagan (1986). That single act was what precipitated the crush of all emergency departments, everywhere. The actual law does give an ED doc the right to say "you are not having an emergency, we're not treating you"; however, case law since has pretty much rendered that ability dead.
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It makes fundamental sense that one should be able to get lifesaving, or at least stabilizing care in an emergency regardless of ability to pay(*). Coupled with this should be some sort of mechanism for the public at large, or the system as a whole to manage those costs. However, given the way medical care is funded in the US I think doing so would be a monumental challenge. Let's be honest, if there weren't hanky panky going on, then Dale Folwell wouldn't have gotten hundreds of pages from (I think it was) UNC Healthcare saying the price for procedure XYZ is ... redacted .. while they simultaneously refused a contract for the state employee health plan that was something like 205% of Medicaid / Medicare figures. In virtually no other industry does the consume get to know the price only after consuming the product and in the case of medical it meets the textbook definition of racketeering with parties operating in private collusion to fix the pricing. I think what we are seeing now is but another symptom of an industry that is in crisis.

* - Important distinction needs to be made between emergency, urgent, and primary care as you said earlier. You'll get at least this much if something happens to you in many foreign countries. I remember back when I was in middle school, every year the 8th grade would go to France over spring break (side note on that, one class got to attend easter mass at Notre Dame). I recall one year, a girl received an appendectomy courtesy of the French govt. Not how I would want to spend my vacation, but better than the alternative.
 
I'd have to think the emergence of urgent care facilities pulled some of the weight off the emergency departments, no? I'm not real good about maintaining a PCP doctor, so getting the sniffles and needing some pills has had me seeking an urgent care on occasion.
 
noway2 said:
It makes fundamental sense that one should be able to get lifesaving, or at least stabilizing care in an emergency regardless of ability to pay(*). Coupled with this should be some sort of mechanism for the public at large, or the system as a whole to manage those costs. However, given the way medical care is funded in the US I think doing so would be a monumental challenge. Let's be honest, if there weren't hanky panky going on, then Dale Folwell wouldn't have gotten hundreds of pages from (I think it was) UNC Healthcare saying the price for procedure XYZ is ... redacted .. while they simultaneously refused a contract for the state employee health plan that was something like 205% of Medicaid / Medicare figures. In virtually no other industry does the consume get to know the price only after consuming the product and in the case of medical it meets the textbook definition of racketeering with parties operating in private collusion to fix the pricing. I think what we are seeing now is but another symptom of an industry that is in crisis.

* - Important distinction needs to be made between emergency, urgent, and primary care as you said earlier. You'll get at least this much if something happens to you in many foreign countries. I remember back when I was in middle school, every year the 8th grade would go to France over spring break (side note on that, one class got to attend easter mass at Notre Dame). I recall one year, a girl received an appendectomy courtesy of the French govt. Not how I would want to spend my vacation, but better than the alternative.
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Payment and funding are a whole 'nother thread. Probably multiple threads. I agree with you, with just about all of it. I totally agree that emergency care should be rendered regardless of being able to pay (at least up front). I hate--loathe--that medical costs are not transparent. Hell, not even people within the same hospital can give you an accurate bottom line: ask five people, get five different answers. If I want a new hip, I should be able to see what each hospital charges, with no hidden costs, anesthesia, rehab, all of it. But you can't find it.

RE: France (and Europe), here's a story: when I worked in the surg-trauma ICU at UNC-CH, I had a coworker (RN) on vacation in France, broke her pelvis. She was in France. After her surgery she was placed in a ward with several other patients, her doc was basically their version of a first year resident. Until they found out she had good American insurance, then she was moved to a private room and had attending-level care. They billed insurance. So those countries WILL flip the bill for medical care on the taxpayer's back, but they are tiered systems, and the more you can pay (or insurance can pay), the better care you get.
 
Timfoilhat said:
I'd have to think the emergence of urgent care facilities pulled some of the weight off the emergency departments, no? I'm not real good about maintaining a PCP doctor, so getting the sniffles and needing some pills has had me seeking an urgent care on occasion.
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Our local Duke UC is as busy as most EDs, and they see sick people: about a quarter will be sent to the ED for further care. But they are the exception, not the rule. Most UCs are good 'gate keepers' and keep people from going to the ED.
 
Only been to an emergency room once. I was 12 years old, and had broken my arm in a bicycle accident.

Sat in the waiting room with my mom for 5 hours only to be told that none of the doctors on staff that day knew how to set a bone, and that we should come back tomorrow.
Left that day with my arm splinted (and still very much bent) , and the very next morning my mom took me to a specialist.

The specialist did a good job, but my arm healed with a significant crook in it. I later had to have surgery to straighten it out so I didn't loose use of my wrist. To this day, I have less movement and strength in my left arm.

Don't go to Whiteville hospital if your life depends on it. You might not make it out alive.
 
RedneckFur said:
Only been to an emergency room once. I was 12 years old, and had broken my arm in a bicycle accident.

Sat in the waiting room with my mom for 5 hours only to be told that none of the doctors on staff that day knew how to set a bone, and that we should come back tomorrow.
Left that day with my arm splinted (and still very much bent) , and the very next morning my mom took me to a specialist.

The specialist did a good job, but my arm healed with a significant crook in it. I later had to have surgery to straighten it out so I didn't loose use of my wrist. To this day, I have less movement and strength in my left arm.

Don't go to Whiteville hospital if your life depends on it. You might not make it out alive.
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When was that? If I was a betting man, those docs weren't EM docs but likely internal med docs or GPs. It's amazing how may small, rural EDs, even today, don't have EM docs. But even if they do have emergency med docs (who know the basics of orthopedic care), many small EDs lack specific equipment to do anything more than basic care.

Duke ED didn't require docs to be emergency med certified until around 2000.
 
RedneckFur said:
Sat in the waiting room with my mom for 5 hours only to be told that none of the doctors on staff that day knew how to set a bone, and that we should come back tomorrow.
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Years ago, before we were married, my now wife tripped and fell down the stairs, breaking her ankle: the bone in the front, broke off and rotated. She went to the ER, major hospital in Akron, OH, not a rural Podunk. They x-rayed it and said, "we don't have anyone who can read this, but we think it's sprained, someone will follow up with you. Several days later, she goes to an orthopedic surgeon who says, "I agree with the x-ray diagnosis, it's broken and had it been set immediately, you would have been able to get a cast and be fine, but now it needs surgery to be reset. WTF!!! The next day they "read" the x-ray and never informed her of the original misdiagnosis.

At the time she had insurance, which became another debacle. At first, the insurance covered it, then all of a sudden, they reneged the payment claiming, "she had reported this as a workman's comp claim" Huh? This happened at home. So, to make a long story short, she wound up with bad credit over medical bills that her parents ultimately put on a credit card and she paid off slowly, however it gets better. I forget which franchise flavor of BCBS was involved, but they lost a class action suit for wrongfully reneging on claims and she got back something like $100.
 
Timfoilhat said:
I'd have to think the emergence of urgent care facilities pulled some of the weight off the emergency departments, no? I'm not real good about maintaining a PCP doctor, so getting the sniffles and needing some pills has had me seeking an urgent care on occasion.
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I think they have, but they are not 24/7 the way the ER is so there is a built in limit to how much they can absorb.
 
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