BETA
This is a BETA experience. You may opt-out by clicking here

More From Forbes

Edit Story

One Doctor's Quest To End The Plague Of Screwed-Up Medical Diagnoses

This article is more than 8 years old.

When the Institute of Medicine released an alarming report in September concluding that diagnostic errors account for 10% of patient deaths in hospitals, Carol Gunn was disturbed, but not at all surprised. Gunn’s sister, Anna, survived breast cancer and myelodysplastic syndrome, but died in 2013 after a wave of heart attacks that went undetected, despite her frequent complaints of chest pain. By the time a cardiologist finally saw her and put in a stent, it was too late—her heart was damaged beyond repair.

“I think it was tunnel vision,” says Gunn, herself a physician who practices occupational medicine. Anna’s doctors were so focused on her other health problems they seemed to ignore her complaints of chest pain, says Gunn, who sifted through her sister’s 14,000-page medical record in search of answers after the loss. “In medicine you’re supposed to consider all the different aspects of what a problem might be. They didn’t go through that process.”

Gunn could have sued Anna’s doctors, but she figured she could make more of an impact by using her own medical training to educate physicians and patients about medical errors—and how they might be prevented. So Gunn started her own website titled “Turning the Tide on Medical Errors.” She did a TEDx Talk, during which she recounted the tragic details of her sister’s death as she struggled to hold back her tears. (See video below.)

Anna Gunn’s story is a rather shocking tale of one missed diagnostic opportunity after another. Whenever she complained of chest pains, the various doctors and nurses who were treating her came up with seemingly random explanations or platitudes. One told her that the drug she was taking to relieve nerve pain that emerged several months after her cancer treatments would take care of the chest pains, too. Even when the pain increased and she lost all feeling below the waist, she was in the hospital for 12 days before a cardiologist was called in for an evaluation.

As the Institute of Medicine (IOM) discovered, situations like that faced by the Gunn family are all too common. The authors of the report, entitled “Improving Diagnosis in Healthcare,” determined that 5% of all people who received outpatient care each year are victims of diagnostic errors, and 17% of adverse events in hospitals stem from misdiagnoses. The authors suggested several solutions, including overhauling medical education so it places more emphasis on diagnostic skills, and improving teamwork among different types of physicians, so the task of making a diagnosis isn’t something that happens inside just one clinician’s brain.

But the prevailing theme of the IOM report—and the one that resonated most strongly for Gunn—was that patients and their families must take on much of the responsibility for avoiding diagnostic errors. They need to speak up when they have questions or complaints, the authors said, and they shouldn’t be afraid to challenge decisions that they think are wrong.

Gunn says that in retrospect, she and her sister should have been more assertive. “We had to be more forceful and more repetitive, and we should have asked to go higher” in the medical chain of command, Gunn says. “We were speaking up, we were sending e-mails, but we were also worried about rocking the boat. Patients worry about that—they think their healthcare provider will stop seeing them if they raise issues over and over.”

Gunn brings a unique mix of experience to the task of reducing medical errors. She began her career as an environmental health and safety engineer for Intel and other companies in Silicon Valley before deciding to change careers and become a doctor. She is board certified in internal medicine, industrial hygiene and occupational and environmental medicine, and she believes her background makes her particularly sensitive to the need to learn from one’s errors.

“I was raised in corporate America first. As a safety engineer in the semiconductor business, I’d get together with all the other engineers and share information, so we could prevent issues from happening to others,” Gunn says. “If we had an issue, we spent several days trying to figure out what happened. That’s what’s missing in medicine.”

Gunn acknowledges that getting doctors to think like engineers when it comes to error prevention will require a major cultural overhaul—a healthcare revolution that won’t happen overnight. In the meantime, she says, patients can do plenty on their own to avoid being victims of diagnostic mistakes. Here are Gunn’s tips:

Tip #1: Get a second opinion that’s completely independent. Although this may seem obvious, many patients make the mistake of seeking out second opinions from physicians that practice in the same hospital or medical group as their primary healthcare provider does. Sometimes a totally fresh perspective is what’s necessary, Gunn says. “It’s important to get an objective second opinion, even if it costs you more money,” she says.

Tip #2: Ask to speak with supporting players like radiologists. Your doctor isn’t making diagnoses in a vacuum. If you have questions about decisions that are being made, request meetings with radiologists, pathologists and other clinicians who are contributing to your case, Gunn suggests. “They have a key role in getting information back to the physicians,” she says. “I don’t think patients are having enough conversations with them.”

Tip #3: Don’t worry about rocking the boat. You may feel like you’re being a troublemaker, but the fact is, your doctor isn’t going to walk out on you if you ask questions, Gunn says. “We were concerned about that, too,” she says. “But if you’re getting more information, and people are now talking about your case, then maybe more will come out of it.”

Ultimately Gunn hopes to be a force for the cultural change that she believes is necessary for reducing diagnostic errors. “We have to set up systems so errors stop occurring,” Gunn says. “When we see a problem we need to stop people before they make a mistake. Anna had chest pain. Her nurses knew it, her doctors knew it, all sorts of folks knew it. And no one went back and asked why she had pain. This is a huge issue. All of us at some point will suffer from diagnostic errors.”

 

Follow me on Twitter or LinkedInCheck out my website