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Monday, May 5, 2014

The Art of Misdiagnosis - Revisited

5:17 AM Posted by Tiffany Taft ,
Over the weekend, I had to put my dog to sleep.  He was 3 weeks shy of his 7th birthday, and while he was a boxer - a breed prone to certain health problems - he was healthy up until about 6 months ago.  However, I never thought within a matter of days of taking a bad turn he'd be gone.  What does this have to do with a chronic illness blog, you may be asking?  As you can imagine I've done a lot of thinking about what the hell exactly happened to my buddy and how it got out of hand so fast.  I've spent a lot of time blaming his vet, who missed the correct diagnosis back in December entirely.  But I have to lay some blame on myself for lack of follow-up until things got bad.  I do have my reasons, and they revolve around an inherent lack of trust in veterinarians based on past experiences.

My buddy around 6 weeks old.
Don't get me wrong, there are wonderful vets in the world who get it right and save pets' lives every day.  This isn't a post to bash the field.  But I also know I'm not alone in my poor experiences, having talked with friends who voice similar frustrations in finding someone they can trust.  And I live in Chicago, where there are probably about 8,000 vets to choose from (that number is not based on any valid data, just one I pulled out of thin air because I'm too lazy to look it up). 

I've already written about misdiagnosis in those living with chronic illnesses, and cited some pretty alarming statistics on how long it can take to get an accurate diagnosis of something like Lupus.  Thinking about what happened with my dog, I also thought more about my thinking during the whole thing and noticed a few themes that may resonate with some of you.

"Why should I bring him back, they're not going to get it right anyway?"  This is where I lay fault with myself.  Overall, my dog was healthy but was eating, drinking, and peeing a lot more; telltale signs of Cushing's disease, but I was told in December that he didn't have that, rather it was likely a bladder infection.  Because he wasn't putting on weight, the vet wasn't concerned about the eating.  In actuality, he ended up losing about 10 lbs because of the muscle wasting that happens with untreated Cushing's. For those trying to find out what the cause of their continued symptoms is, I can imagine similar thoughts going through their mind.  The key to the doctor-patient relationship is trust, and being told the wrong thing by someone who's the expert leads to obvious erosion of that trust.  The hard part is not to generalize negative experiences with a few doctors to all doctors and stop going in when follow-up is clearly warranted.

"All they want to do is order expensive tests."  This thought was usually followed by the first thought.  We don't have pet insurance so everything was out of pocket.  There's been a lot of discussion about the uninsured in our country and the importance of not letting financial concerns get in the way of access to quality healthcare.  It was troublesome to have to consider costs with my dog, which were in the thousands of dollars in a matter of days, I can't even fathom having to weigh this for myself or a loved one.

"They're making assumptions based on his breed."  Between Wednesday night and Saturday afternoon I was told my dog had metastatic cancer to his lungs (he didn't) and cardiomyopathy (unknown) by 2 different emergency vets. In between these 2 fatal diagnoses, he was accurately diagnosed with Cushings, but unfortunately it was too late to do anything about it. The ER vets made assumptions about him because he was a boxer, a breed prone to both cancer and cardiomyopathy. Anecdotally, I know this happens in the human medicine world as I've heard stories from my clients.  Research on stigma tells us that physicians make assumptions about patients who are obese, mentally ill, or addicted to substances and may not provide the same level of care as they would to someone not in one of these categories.  Gender, racial, and ethnic differences also exist in patient satisfaction (women and racial/ethnic minorities tend to be less satisfied).  I would guess sexual orientation and identity also play a role.

"They're not focusing on the problem at hand."  This last thought kind of combines the previous 3 in that I felt that the vets I've seen, whether it was for my dog or other pets I've had who have had health issues, get off on a tangent.  For example, when I took in my 16 year old cat a year ago the vet was more focused on him needing his teeth cleaned than what turned out to be colon cancer (completely missed until it was, again, at its worst stages).  When the ER vet started talking about cardiomyopathy I became frustrated that he was ignoring the possibility that my dog's symptoms could have been brought on by heart damage from the untreated Cushing's. When I asked outright, he said it was possible but not likely because of his breed (see point 3).  Clients that I see will sometimes talk about feeling "medicalized" and that they've been sucked into the system never to escape and return to their normal lives.  Many illnesses require periodic monitoring or screening, whether it's blood tests, scopes, or scans, to make sure the disease isn't active.  While important, these can also have a negative psychological impact of having to think about their illness that may otherwise be quiescent, and worry about "what if" the test comes back abnormal.  Sometimes the test finds an entirely new problem, leading to another diagnosis and more treatments.  It can be quite the emotional roller coaster.


My buddy at 6 years old.
Whether it's a pet, yourself, or a loved one I truly hope you don't share in these experiences.  What I wanted to highlight here was how my overly negative thinking affected what I did in this situation.  Do I think some of my beliefs were warranted based on my experiences?  Sure, but in the end they didn't really do much to help my dog.  I'll never know if he would have been helped, really, because I don't know what ultimately did him in.  If you're going through a frustrating process of finding answers to your health concerns, check your thoughts and how they might be influencing your choices.  

Best,
Dr. T