Difficulties with diagnosis: Boston Globe takes it on

I’m impressed that the Boston Globe printed a number of insightful letters in response to its Mistakes that matter article, which discussed the case of two patients whose prostate cancer biopsies got mixed up. (One had cancer, the other didn’t. The one without cancer got surgery as a result of the mixup, the one with cancer had delayed treatment and possibly negative consequences as a result.)

Two of the four letters are from patients who were tested for cancer. The best is one from Irving Sacks of Peabody, documenting how he searched widely for alternative treatments after being diagnosed with cancer of the esophagus. In the end he found out from a medical center in California that he had another condition –not cancer– and didn’t need the proposed surgery to remove his esophagus. He says (and I concur):

When confronted with a life-threatening medical assessment, do not rely on a single diagnosis, and, when getting a second opinion, go outside the network, even to another city.

Edgar Dworsky of Somerville wasn’t persuaded that he had prostate cancer after the first pathologist said the slides were “suspicious for cancer,” so he took the same slides to another pathologist who said he “definitely” had prostate cancer and a third who said the slides were “highly suspicious for prostate cancer.” Based on that set of findings he’s decided he doesn’t (yet) have prostate cancer and has embarked on a program of watchful waiting rather than active treatment. At least from what he’s written it’s a little hard to follow his logic but for his sake I hope he’s right.

Arthur Rosenthal of Salem points to a New England Journal of Medicine article (Mortality Results from a Random Prostate-Cancer Screening Trial) that showed screening didn’t make it less likely that those tested would die from cancer. As Rosenthal points out, screening may not save you from dying from cancer but it can induce worry by making you think you do have cancer. I agree with that.

Finally, Dr. Donald Ross, past president of the Massachusetts Society of Pathologists, but writing on his own behalf, says the problem is profit-driven corporate labs. Unlike hospital-based practices such as his, which he asserts follow precautions to avoid mix-ups, such labs drive through so much volume that they increase workload and lead to errors. I’m willing to keep an open mind on Ross’s point, but he doesn’t cite evidence showing lower error rates. I’m also unconvinced that profit-seeking companies are any more interested in revenue than independent physicians.

In any case I’m glad to see the Globe provide so much information on the practical challenges in getting the right diagnosis.

August 9, 2010

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