The Most Commonly Misdiagnosed Conditions
A study in 2019 analyzed US malpractice cases from 2006-2015 and found a common trend within them. These records uncovered that nearly 75% of harmful misdiagnoses were a part of what was categorized as the "big three.” These “big three” were cancer, vascular events, and infections. A different study from the Journal of the American Medical Association (JAMA) analyzed malpractice claims, incident reports, ambulatory conferences, and focus groups from 2004-2016 and found similar results in the top ten most common misdiagnoses. All ten could be categorized as either cancer, vascular events, or infections. But why is this the case? What makes these three events so hard to diagnose?
According to the 2019 study, cancer was the most common misdiagnosis out of the “big three.” The most common cancers were lung cancer, breast cancer, colorectal cancer, and prostate cancer.
Cancers can be challenging to diagnose for many reasons. First, they share many similar symptoms with other diseases and conditions and, depending on the type of cancer, are often mistaken for less severe conditions. For example, lung cancer is usually misdiagnosed as pneumonia, asthma, chronic obstructive pulmonary disease, tuberculosis, and more.
For colorectal cancer, younger people are more likely to be diagnosed correctly only at advanced stages. Some reasons for this include that they are less likely to go to the doctor early on and both patients and doctors share a lack of awareness of younger onsets of colorectal cancer. This problem can commonly be seen with other types of cancer as well.
But misdiagnoses can waste precious time, and some people may find themselves finally correctly diagnosed after the cancer has become aggressive and harder to treat.
Vascular events seem to be the next most common conditions misdiagnosed. The word vascular refers to your veins and arteries (the blood vessels that carry blood across your body). The most commonly misdiagnosed vascular events are strokes, heart attacks, pulmonary embolisms, and brain hemorrhages.
Non-specific, temporary, and less well-known symptoms can make vascular events less recognizable to medical providers. For example, heart attacks are more likely to be underdiagnosed in women because women have been known to experience different heart attack symptoms than men. Therefore, because heart attacks are understudied in women compared to men, doctors are less likely to recognize them in women and more likely to write them off as stress or anxiety.
Younger people, those of racial and ethnic minorities, and women are also more likely to be misdiagnosed for strokes. The reasoning for this is still largely debated.
Infections are the third most common conditions misdiagnosed. Sepsis is the most common infection misdiagnosed, but meningitis and encephalitis are also commonly misdiagnosed infections.
Sepsis is your body's extreme immune response to an infection and can be triggered by existing infections like UTIs, GI infections, etc. This response can be deadly and requires immediate medical attention. According to the CDC, 1 in 3 people who die in a hospital have sepsis.
However, sepsis is also one of the more complicated conditions to treat and requires a quick diagnosis and identification of the infection site. One study in 2019 found that an early misdiagnosis or failure to identify the location of infection doubled the odds of in-hospital mortality.
Other Commonly Misdiagnosed Conditions
Lyme disease is a bacterial infection that is carried and spread through ticks. It is also commonly misdiagnosed for several reasons. One reason is that the bacteria that cause lyme is difficult to identify from lab tests. This can lead to a false positive (when the patient instead has a different bacterial infection) or a false negative. Lyme disease is often also misdiagnosed because of how similar it appears to other diseases. Often Lyme disease can be mistaken for fibromyalgia, chronic fatigue syndrome, arthritis, and multiple sclerosis.
Celiac disease is a disease that causes damage to the small intestine when gluten is ingested. To test for celiac disease, you must undergo a serologic (antibody) test and then a small intestine biopsy to check for damage (a sign of celiac disease).
Incorrect interpretation of celiac antibody test results, insufficient biopsy evidence, and incorrect interpretation of biopsies contribute to the misdiagnosis of this disease. For example, a study found that 8.6% of biopsy samples used to provide a celiac diagnosis had insufficient evidence.
Another large discrepancy occurs when a patient has a positive serologic test, but normal biopsy results, leading to an unclear diagnosis.
Lupus is an autoimmune disease that causes your immune system to mistake your body's normal cells for foreign invaders and attack them, leading to inflammation and organ damage.
A large point of error is in the way lupus is diagnosed. Lupus can be tested using an antinuclear antibodies (ANA) test. However, a positive test does not always indicate lupus. Diseases like fibromyalgia can also have a positive result. Regardless, some doctors unfamiliar with the disease may automatically assume a positive ANA test means lupus.
Another issue with this disease is the slow show of symptoms that some people experience. Symptoms can appear and disappear over months and even years, making it hard to spot the disease's characteristics. Lupus can also appear very similar to and be mistaken with other autoimmune diseases, most commonly rheumatoid arthritis.
How the Medical Field is Trying to Decrease Misdiagnoses
Just as you don't want to be burdened with a misdiagnosis, your doctor probably doesn't want to be the one to misdiagnose you. Most doctors want what is best for the patient and are not interested in being sued.
Because of this, the field of medicine is researching ways to prevent these misdiagnoses. Some of these ways include clinical decision support tools, result notification systems, more education and training on the diagnostic processes, and review of diagnoses by medical colleagues.
It's easy to blame medical staff, but it's important to understand that diseases are complicated, perplexing, and variable. The occupation is also experiencing high burnout rates for various reasons so it’s good to be conscientious of medical staff’s work loads and emotional burdens.
How You Can Lower Your Chances of Misdiagnosis
Diagnostic technology is being created and improved constantly, but even so, a lot is still unknown in the realm of medicine. Therefore, as the patient, it's important to do as much as possible to prevent a misdiagnosis.
Young adults are especially susceptible to misdiagnosis. More often, young adults (especially men) neglect to visit the doctor until there is an emergency. As a result, it can be challenging to spot diseases in the early stages (usually when they are easier to treat). For some diseases, early symptoms can appear like typical symptoms for young adults, especially under the guise that cancers, vascular events, etc., only happen to older people.
Additionally, young adults with a family history of certain genetic diseases like cancers and diabetes should inform their medical providers and get screened as often as recommended.
On the other side of the spectrum, older people are also at a higher risk for misdiagnosis. Seniors with memory issues may have difficulty remembering symptoms, past medical history, and directions given by a medical provider.
Older adults are also more likely to take multiple medications at one time. As a result, some misdiagnoses are because two medications taken together are causing a reaction the provider isn't familiar with and may mistake for a condition.
Self-advocacy is a crucial step in preventing these diagnostic errors. Make sure you clearly voice your issues and concerns, correctly provide you and your family's detailed medical history, and keep track of your medications, progress, mental health, and more.
Most appointments are short, so you want to ensure you get the most out of them. Guava can help you stay prepared and ahead of your health. You can use the app to log medications, store your medical records, and keep track of your symptoms. When the time comes for a new doctor's appointment, you can then use our visit prep feature to pull all this important information into an organized and easy-to-understand summary. From there, you can confidently answer every and all questions a doctor might ask during your visit. Your doctor can best help you if they understand the full picture.
Lastly, if you feel like your doctor isn't listening to you or keeping your best interests in mind, it could be time to find another doctor or get another opinion. Always listen to your instincts and your body because no one knows you better than yourself.