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Can anything be done to prevent hospital misdiagnoses?

Posted: April 28, 2017

CBC RADIO Wednesday April 19, 2017

In just three months, there has been a spate of misdiagnoses in Canadian emergency rooms, some with tragic results.

A three-year old girl in Abbotsford, B.C.,died after her pneumonia went untreated, despite repeated visits to the hospital.

In Mississauga, Ont, after being sent home twice with a diagnosis of influenza, an 11-year old girl had her left arm and right leg amputated from a serious infection.

For Megan Shalley, a diagnostic error in an ER resulted in the death of her five-year-old son Sam who died of pneumonia.

Shalley says on the first visit to the ER when her son had a fever and was struggling to breathe, an intake nurse said Sam had croup.

“I thought I might as well take him home because I knew how to treat croup and I didn’t want him laying on the floor in there for four hours,” she tells The Current’s Anna Maria Tremonti.

Shalley explains that the hospital did call to check up on Sam and that was treating him with a vaporizer. But when he was noticeable getting worse, she went back to the ER that same day.

“He was at that point of not eating. He’d lost weight. You could just tell by lifting him. He wasn’t lucid,” Shalley recalls.

Sam’s last ER visit

“When we arrived he was gasping for air and I ran him in in my arms. They took him into triage and then after that, they were just about to send us back out to the waiting room when another nurse came around and said, ‘no just wait.”

Shalley tells Tremonti that she went to the hospital four times in total.

“Sam’s lips were turning blue … I just loaded [the kids] all in the car and I drove him there as fast as I could. I’m very sure that he died in the car,” Shalley says emotionally.

Shalley says Sam never had a chest Xray nor blood tests. The cause of his death was pneumonia and he tested positive for Step A.

Medical errors not public

Statistics on misdiagnoses in Canadian hospitals are hard to come by and patient and health advocates say there isn’t enough access to records.

“Far too much information that should be out in the public without any question whatsoever is hidden and a lot of that has to do with mistakes, errors,” says Natalie Mehra, the executive director of the Ontario Health Coalition.

“So it’s not even known … to what extent hospitals are collecting systematically information on misdiagnoses, let alone having that information available for public scrutiny.”

ER doctor Pat Croskerry heads a groundbreaking program to train medical students to think differently — and stop diagnostic errors before they happen.

He estimates around 10 to 15 per cent of misdiagnoses.

“Which would mean that the doctor has the wrong diagnosis, they’ve missed the diagnosis or there’s been an unreasonable delay in making the diagnosis as has happened in the case of Sam,” Croskerry tells Tremonti.

“Nobody’s quite sure what the real number is but we do know there is a significant failure rate.”

Croskerry explains he teaches medical students the principles of critical thinking.

“You would think by the time somebody gets to medical school that they’re pretty critical thinkers. But but the evidence is that we’re not,” he says.

A strategy known to doctors as being reflective of their environment is often used in surgery, Croskerry points out.

“If you stop and just think about where you are that fewer mistakes tend to happen.”

Croskerry believes ER physicians do worry about their diagnosis of patients and use strategies to minimize problem but warns that doctors have to be aware “there’s a tremendous amount of uncertainty in medicine.”

“And you are at risk for getting it wrong.”

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