A guide to misdiagnosis

Written in collaboration with Dr Charlotte Panuschka, MD

Prior to joining Teladoc Health (previously Advance Medical) as a Senior Physician Case Manager, Dr. Charlotte Panuschka was a visiting fellow at the Department for Otorhinolaryngology Head & Neck Surgery at Guy’s Hospital in London, UK.

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In this misdiagnosis series, we’ve been talking to Dr Charlotte Panuschka, who’s a Senior Physician Case Manager at Advance Medical – the provider we use for our Virtual Doctor service. We’ve been finding out more about what a misdiagnosis is, commonly misdiagnosed conditions and why they’re often mistaken, as well as how it can be avoided. 

A misdiagnosis is when a medical professional makes an incorrect judgement on your symptoms and diagnoses you with the wrong thing. As an example, imagine you’d seen a doctor about ankle pain and had been diagnosed with a sprain, and advised that it would heal on its own with rest and pain killers, but later discovering that you’d actually fractured your ankle and needed further treatment. 

A misdiagnosis can have a range of consequences, from being given the wrong medication, to delaying treatment for a more serious condition altogether. When making a diagnosis, a primary care medical practitioner will ask about your symptoms and take medical history and review results from any diagnostic tests, and then use professional judgement to understand what the problem is. 

The World Health Organisation (WHO) reported that approximately 5% of adults in high-income countries are misdiagnosed during out-patient appointments each year. This can simply mean being treated with an ineffective medicine, but unfortunately, the WHO has found that over half of misdiagnosis cases could have caused harm.

A misdiagnosis often seems to form part of the diagnostic process because many conditions share similar symptoms, and without a specific test it can be hard to tell one from another. It’s down to the doctor to understand what the condition is likely to be and make an interim diagnosis until they can be sure it’s nothing else. Sometimes this means trying one form of treatment and seeing if it improves your condition, and if not, trying another. There are a number of conditions which are more commonly misdiagnosed than others, you can find out more about them, here. 

The latest report from Advance Medical – who provide our expert Second Medical Opinion service – showed that of the cases they looked at between May and December 2019, 13% of cases had a minor adjustment, meaning that a misdiagnosis, if there were one, would only slightly affect the patient’s treatment plan without a negative effect on their long term prognosis. Nonetheless another 5% had a major adjustment to their diagnosis, which may have therefore resulted in more serious medical impact, potentially affecting long-term prognosis. 

11% of cases also had a major change to their subsequent treatment, with an additional 37% being suggested a minor change. Although the majority of cases still had no change to treatment or diagnosis, an independent review can give patients the reassurance that they’re receiving the most appropriate treatment and help them understand their diagnosis – and that is ultimately what is sought, to pursue a direction that they know is appropriate.

Minor adjustments are changes to a diagnosis that would only slightly affect the patient’s treatment plan without a negative effect on their long-term prognosis.

Major adjustments to a diagnosis may result in serious medical implications, affecting the patient’s long-term prognosis.

Misdiagnosis around the world 

Misdiagnosis rates vary widely around the world. It’s a global issue and recognized as a problem in different cultures around the world. It occurs in low to middle, as well high-income countries, with varying factors. This is partly because of the lack of access to quality primary care for many people in low income countries, along with a lack of availability of health care providers and specialists. There’s also limited access to diagnostic tests, and these things, with the varying medical systems around the world, breakdowns in care coordination and communication, and poor medical record-keeping of patient history in many areas of the world, accuracy often falls short. It’s an issue that many expats face when moving between countries. If your medical history and treatment notes aren’t moving around with you, it can be hard for doctors to paint a real picture of the situation and what’s happened so far. 

Differences in regulation and legislation around the world for medical records can cause problems when trying to access medical history. In some countries primary care doctors play an important role as the entry point into the health care system and keep a record of tests, while in other countries, patients receive care directly at hospitals and patients have to navigate themselves through the system, meaning there’s often no one point of reference. All this makes it challenging for patients to keep track of their test results and other medical documents, even more so when they’re frequently travelling between systems.

How can you avoid a misdiagnosis?

Dr Charlotte Panuschka from Advance Medical, has written a handy guide to help give you some ideas of what you can do as a patient to avoid a misdiagnosis. Take a look, here.

Don’t forget, as an AXA – Global Healthcare member, you have access to an independent second medical opinion, so you can be sure you’ve received the right diagnosis and the best treatment plan for you and your situation. 

Whether you just have some questions about your treatment plan, or you want a full review of your diagnosis, we work with independent medical experts to get you the answers and reassurance you need. You can find out more about the service and how to request a second medical opinion, here. 

The information in this article is correct at the time of publishing.

Sources: 

1. https://apps.who.int/iris/bitstream/handle/10665/252410/9789241511636-eng.pdf