Perspective: A skeptic views the medical news

By Charles A. Pilcher MD FACEP
July, 2017

“Over 20% of patients may be misdiagnosed by PCP’s” Really?

That was the headline back in April. The Washington Post and other national media gleefully reported that over 20% of patients are mis-diagnosed by their primary care physicians. This is nothing more than “press release journalism,” aka “fake news” that results from simply parroting the contents of an author’s self-aggrandizing quest for notoriety through a press release. The “journalists” never bother to read the study. Editors simply produce the headline that will generate the most eyeballs. That’s like conducting a trial in a courtroom in which only one side gets to present its case. Hopefully readers of Medical Malpractice Bulletin are as skeptical as I am and do the philosophy of “I read it on the internet so it must be true.”

So what does the report VanSuch et al. in the Journal of Evaluation in Clinical Practice really say?

The study involved 286 patients referred to the Mayo General Internal Medicine Clinic by primary care providers including physicians, PA’s and ARNP’s. The clinic provides second opinions for “patients with ambiguous, uncertain, and undiagnosed problems.” They see the most difficult patients with the most complex and atypical symptom complexes. Mayo docs don’t get the easy cases. The patients were not dissatisfied. They did not choose to go to Mayo. They were referred.

In my mind, the real news here is that in almost 80% of cases, primary care providers got it right. The Mayo docs were no smarter than the patients’ own PCP’s. The PCP’s also deserve credit for being smart enough to recognize that their patients’ presentations were deserving of a second opinion. They were referred because their diagnosis was unclear. That’s what the Mayo Clinic and others like it are for.

So why is this story news? The real news would be a study in which diagnostic errors were made in 20% of patients whose doctors never referred them for a second opinion. If that were true, plaintiff attorneys would have a lifetime of work, malpractice insurance would be unaffordable, and insurers would have long ago gone bankrupt.

I love being a skeptic. If you missed it, check out my other recent rant on “press release journalism” from the >>> LINK issue of this Bulletin. That was the one about the over-stated benefits of a new cholesterol-lowering drug. Spoiler alert: The drug would benefit so few patients that it would potentially cost $28,000,000 for each patient helped.

Let’s not rely on NBC or the the Washington Post for updates on medical “breakthroughs.”

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