Getting the Best Medical Care: a Newsletter from Patrick Malone

In This Issue

How Bringing an Ally to the Doctor's Office Can Help You Get Better Care

More Reading on Getting the Right Diagnosis

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Helping Your Doctor Make the Right Diagnosis

Dear Patrick,

Here's another summer issue of our patient safety newsletter, on a topic of four-season importance: getting to the right diagnosis when your doctor is unsure. There's a lot you can do to steer your medical ship to safe harbor. Read on for more.

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Bring an Ally with You to the Doctor's Office

The elderly woman whose diagnosis story was told recently in the Los Angeles Times was the unfortunate recipient of knee-jerk medical care. But she was fortunate in having her child as an advocate who did an end run to solve her medical mystery.

A physician diagnosed the mother with a urinary tract infection, but didn't prescribe antibiotics because she is allergic to most of them. Her condition did not improve. Because the doctor was unaware of or unwilling to investigate other treatments, and didn't consider the possibility of a misdiagnosis, the child turned to The Times' health-care columnist for advice.

Misdiagnosis and/or improper treatment, as we've previously noted in our patient safety blog and in this newsletter, is hardly unusual, and the paper suggested that something was missed in this case. Sometimes a positive urine culture does not, in fact, disclose a urinary tract infection. Sometimes lab results can be misread.

Elderly people are more likely to experience an overactive bladder; other conditions that might have been overlooked can cause recurring urinary tract infections. Interstitial cystitis can mimic a urinary tract infection, and a prolapsed pelvic floor can compromise the ability to fully empty the bladder.

As noted in the article, "'Medicine is a deductive science, rather than something we can see and know for sure,' said Dr. Lisa Sanders, a primary care physician at the Yale University School of Medicine." Dr. Sanders writes a column on medical mysteries in the New York Times Magazine.

The patient and/or his or her advocate often must be the case manager. That means being prepared before seeing the doctor - bring your medical records, a list of your symptoms and topics you want to discuss. As Sanders told the L.A. Times, "A doctor's appointment is more like a meeting between two kinds of experts - the patient, who is expert on their own experience, and the doctor who is expert on the broader issues."

Don't be timid. Ask questions, and if you're not satisfied or don't understand the answer, ask again. If you've been treated and it hasn't worked, tell your physician that you remain unwell and ask if it's possible that you've been misdiagnosed, if another disorder might be causing the symptoms.

That's where bringing an advocate to your appointment can really help; it's easier to be proactive when you can let your ally ask the tough questions.

Everyone deserves a doctor who is willing to listen to the patient and her advocate, and to fully explore the possibilities. An elderly patient should consult a specialist in geriatric medicine, who understands how some symptoms present differently in older people, and who knows the health problems they are more prone to experience. In this case, apart from gynecology, there are even specialties in female urology and voiding dysfunction. (Read the next article for resources on finding a new doctor.)

To ensure continuity of care, the primary care physician should be kept apprised of all doctor visits, tests and treatment information gleaned from different sources.

Resources for Finding the Right Doctor

Sometimes you have to give up on one doctor and change course. Your instincts will help you know the right time: When the doctor isn't listening, or seems stubborn, or otherwise is floundering.

Here are some resources for finding the right caregiver:

People covered by Medicare can search for providers on the Medicare website using the "Resource Locator" link at the top of the home page. Local teaching hospitals are also good resources, as they're most current on research and treatments, and often aren't constricted by the time restraints many private doctors must impose in order to make a living.

Another care resource is associations or foundations dedicated to certain disorders.

Patient advocacy organizations might be able to help. The mission of In Need of Diagnosis, for example, is to advocate "for changes in the medical system that will increase the accuracy and timeliness of diagnosis. It is a resource for people who suffer with illnesses that elude diagnosis." It's not a medical facility, so it doesn't diagnose, but the nonprofit organization helps match patients with appropriate caregivers.

More Reading on Getting to the Right Diagnosis

We also tackled the important subject of misdiagnosis in Issue No. 16 of this newsletter, which gave important advice about helping your doctor get to the right diagnosis. We started with the essential question you always need to ask, and we moved on to a list of other vital questions that should be on the list you take to the doctor's office.