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This site is an archive of our Well Written Blog posts until April 2020. For the most up-to-date content visit NWIJournal.com.

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Missing the DX

Posted By Molly McGuane, Wednesday, April 17, 2019
Updated: Tuesday, May 7, 2019

It’s estimated that every year 12 million people in the United States are affected by a misdiagnosed disease or condition. Incidences of cancer misdiagnosis can be particularly concerning, unfortunately altering the course of a person’s life. In the beginning stages of many cancers, symptoms can be vague and difficult to differentiate from more common illnesses. A misdiagnosis early on can be very detrimental and potentially lethal if the cancer continues to grow and spread. While the fault of a misdiagnosis of a disease doesn’t necessarily fall on a specific doctor or healthcare team, there are steps that doctors and patients can take to reduce the instance of a misdiagnosis.

Commonly Misdiagnosed Cancers

Melanoma

Woman with a tan applying sun blockAs an unfortunately common skin cancer, melanoma takes the lives of nearly 9,000 patients every year. Melanoma is caused by exposure to UV radiation that is generated from tanning beds and from exposure to the sun. Melanomas emerge on the skin as an irregular-looking mole or dark spot on your skin, but can be easily missed or misdiagnosed.

Health care providers and patients can be more vigilant about their skin by remembering the anagram ABCDE when looking at their moles and beauty spots. “A” stands for asymmetrical, “B” for irregular borders, “C” for abnormal color, “D” is for diameter, and “E” is for evolving in shape or size. These signs shouldn’t be ignored and moles or marks with these characteristics should be tested by a pathologist.

Primary care doctors and physician assistants should also recommend that patients see a dermatologist annually or biannually based on their risk. They should also encourage patients to perform “self check-ups” regularly to be alert of any new or changing skin lesions. Extra diligence could lead to a more accurate and early diagnosis, which is crucial in skin cancer and melanoma cases.

Colorectal Cancer

In many cases, cancer of the colon or the rectum often begins as a growths known as polyps, that grow in the walls of these areas over time. The best way to find colorectal cancer early is through screenings, but the problem of misdiagnosis comes when symptoms are misunderstood and screenings are done too late.

Symptoms of colorectal cancer can be uncertain, like unexplained weight loss, fatigue, and a change in bowel movements and symptoms like these can be misunderstood even by medical professionals, especially in younger patients. Most frequently, colon cancer can be misdiagnosed as irritable bowel syndrome (IBS), diverticulitis, and ulcerative colitis due to similar symptoms including rectal bleeding and abdominal pain.

If pain continues or new symptoms arise, a colonoscopy or CT scan might be necessary to check for any serious issues. It’s also important to keep in mind that colorectal can be genetically connected and 1 in 3 people who are diagnosed with colorectal cancer have a familial connection. Understanding a patient's family history is an important step in diagnosing disease and can provide additional insight into their symptoms. While it’s on the patient to know their family history, healthcare professionals can assist by impressing the importance of knowing that history upon their patients and making sure to ask when issues arise.

Lung Cancer

Man smokingThe most widespread cancer globally is lung cancer, and it can be caused by a number of environmental factors. The most obvious reason for developing lung cancer has historically been smoking and secondhand smoke, but cancers of the lung can also arise from elements in the air and invisible and odorless carcinogens we may not even realize that we are exposed to.

Symptoms of lung cancer, and related cancers of the lung like mesothelioma, often first appear as a persistent cough, pain in the chest, or shortness of breath. These symptoms could be easily misdiagnosed as asthma, COPD, or even a common cold. Lung cancer and mesothelioma are common occupational cancers, so knowing a patient’s occupational history can also lead to a better understanding of their condition. Those who have worked as firefighters, miners, and in the construction industry are more vulnerable to carcinogens like asbestos and silicates.

Breast Cancer

Understanding a patient's family medical history can also help in being vigilant about the beginning stages of breast cancer. Breast cancer affects 1 in 8 women in the United States and the risk of a patient developing breast cancer can nearly double if a mother, sister, or daughter has also been diagnosed.

The beginning stages of breast cancer develop as a lump in the breast tissue but can be missed entirely if screening isn’t done frequently enough. Breast cancer screens are done routinely at primary care and OB-GYN appointments, and self checkups can also be performed to check for any abnormal bumps.

If there are any abnormalities in a mammogram, a follow-up imaging screening, mammogram, or biopsy should be scheduled in a timely manner so that the potential cancer does not worsen. Those who are at a higher risk for developing breast cancer need to communicate that risk with their primary physicians and specialists as well as their family history for the most accurate and timely testing.

How are we Closing the Gap?

Missing a cancer or other disease diagnosis can have regrettable consequences for patients and their families. Both healthcare professionals and those they treat can play a role in a misdiagnosis and they are an unfortunate reality of human error. However, the medical community is taking the time to learn from mistakes and invest in technology that analyzes stored data and can close the gap on inaccuracy. Being able to log patient data from around the world can help better understand symptom patterns and allow for more accurate testing, including mammograms and lung cancer screenings.

The use of artificial intelligence and telehealth in the medical field is helping connect the dots on cancer symptoms, but there is still a lot of ground to cover in perfecting these technologies in the real world. Today, AI should just be used to augment the human work of healthcare and there is still an active role doctors and other professionals can take to avoid a misdiagnosis.

Physician's assistant going over a patient's medical history.

Discussing personal, family, and occupational history and impressing the importance of gathering and communicating that information on your patients is vital to their well being. The more information you know about their health and history, the more accurately you can understand their symptoms. Recommending patients to keep up with an annual schedule of appointments and cancer screenings is another way primary care physicians can help their patients be preventative and avoid a missed or late diagnosis. Communicating closely with every healthcare provider working with the patient including nurses, radiologists and lab technicians is important for everyone’s understanding. Attention to detail and thorough communications will ensure that no important information is missed.


Molly McGuaneMolly McGuane is a communications specialist and health advocate for the Mesothelioma and Asbestos Awareness Center. She is passionate about informing others on cancer prevention and rare disease. Molly's areas of content expertise are cancer prevention, rare disease, occupational health, and asbestos exposure.

Tags:  clinical practice  emotional wellness  medical care  misdiagnoses  Physical Wellness 

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Scanning for Lung Disease Could Become More Common than Breast Cancer Screens

Posted By NWI, Thursday, August 1, 2013

Lung Disease ScreeningsThe U.S. Preventative Services Task Force (USPSTF) posted a report and draft recommendation on July 30, 2013, related to lung cancer screenings. All recommendations undergo a period of public comment.

Based on the available evidence, the USPSTF recommends screening people who are at high risk for lung cancer with annual low-dose CT scans, which can prevent a substantial number of lung cancer-related deaths. This is a grade B draft recommendation.

Smoking is the biggest risk factor for developing lung cancer, resulting in about 85 percent of lung cancers in the United States. The risk for developing lung cancer also increases with age, with most lung cancers occurring in people age 55 or older. After reviewing the evidence, the USPSTF determined that the benefits of screenings outweigh the harms in healthy individuals who are 55 to 80 years old and have a 30 pack-year (a 30 "pack-year” is one pack a day for 30 years or any equivalent such as 2 packs a day for 15 years) or greater history of smoking, who are either current smokers or have quit in the past fifteen years.

According to the task force, nearly 90 percent of people who develop lung cancer die from the disease, in part because it often is not found until it is at an advanced stage. Screenings would allow healthcare providers to catch the disease while it is still treatable.

As a comparison, according to data arranged by National Public Radio, screening is expected to save one life for every 320 people screened. It takes 900 to 1,900 mammograms to save one life from breast cancer (depending on whether those screened are older or younger).

Why does this matter to you? You can’t treat a disease you don’t know exists. And often, the appearance of symptoms occurs when a disease is too far advanced to effectively treat. Although this recommendation still must go through a public comment period to have it included in standard, insurance-covered, screenings, you may consider the option if you have met the smoking threshold as described above.

About USPSTF: Created in 1984, the USPSTF is an independent, volunteer panel of national experts in prevention and evidence-based medicine. The Task Force works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.

Task Force memberscome from the fields of preventive medicine and primary care, including internal medicine, family medicine, pediatrics, behavioral health, obstetrics and gynecology, and nursing. Their recommendations are based on review of existing peer-reviewed evidence and are intended to help primary care clinicians and patients decide together whether a preventive service is right for a patient's needs.

The Task Force assigns each recommendation a letter grade(an A, B, C, or D grade or an I statement) based on the strength of the evidence and the balance of benefits and harms of a preventive service. The recommendations apply only to people who have no signs or symptoms of the specific disease or condition under evaluation, and the recommendations address only services offered in the primary care setting or services referred by a primary care clinician.

Tags:  August 2013  Medical Care  Physical 

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A Prescription for Health: Following Doctor’s Orders?

Posted By NWI, Thursday, August 1, 2013

Medical ComplianceRecent studies reported in the journal Psychological Science (July 2013) estimate that failure to follow doctor’s advice may increase healthcare costs by up to $100 billion a year.

In a series of studies, Gaurav Suri and colleagues from Stanford and Tel Aviv Universities tested whether this status-quo bias (doing what you usually do versus changing based on a doctor’s advice) could result in behavior that is detrimental, and whether such a bias could be lessened with minimal interventions.

Not doing what your doctor suggests, also called medical noncompliance, such as not taking a prescribed medication due to fears about side effects, dosing requirements such as taking a pill every morning with food, or simply, an individual not wanting to change the way they currently do things (status quo), is as much about cost savings as it is about health and readiness for change.

The studies demonstrated that, when faced with a choice that requires a proactive decision, people often opt do nothing, even when actions that are easy to perform could noticeably improve their current state. However, when individuals where required to be proactive in earlier rounds of the study and then allowed to decide to act proactively later, they were more apt to be proactive when given a choice.

Why does this matter to your health? While medical noncompliance may sometimes result from patient inaction, the researchers conclude that people may be capable of making productive choices about their health if given a nudge in the right direction.

G. Suri, G. Sheppes, C. Schwartz, J. J. Gross.Patient Inertia and the Status Quo Bias: When an Inferior Option Is Preferred. Psychological Science, 2013; DOI:10.1177/0956797613479976

Tags:  August 2013  Emotional  Intellectual  Medical Care  Physical 

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It's What You Don't Say: How Doctors Look Beyond Vocalized Symptoms to the Whole Person (Oct. 2011)

Posted By National Wellness Institute, Saturday, October 1, 2011
Updated: Wednesday, December 19, 2012

Ever wonder what your body language is telling your doctor? Plenty, according to a new study by the University of Michigan Health Systems. Through videotaped sessions, researchers were able to identify subtle messages that had an influence on medical care.

The researchers hope the study will improve care by educating doctors on the subtleties of how they make decisions and on what messages they are unknowingly conveying to patients. The study found patients relied on non-verbal clues to evaluate the doctor-patient relationship, focusing on whether the doctor seemed hurried or put them at ease. Doctors, on the other hand, reported that patients' tacit clues influenced their medical judgments. Lead author Stephen G. Henry, MD, a research fellow at the Veterans Affairs Ann Arbor Healthcare System and Department of Internal Medicine at the University of Michigan explained that patients and doctors had very different interpretations of these clues and gestures.

The study is exploratory and did not examine whether the clues led to better or worse judgments.

Doctors who were studied reported using tacit clues to aid in diagnosing a patient, such as observing the patient in a general way for signs that they might be depressed or that they were not revealing the whole of their concerns. The way patients comport themselves may give a doctor clues as to whether non-specific symptoms like weight gain, fatigue, and high blood pressure are signals of depression or whether something else may be responsible.

Patients, on the other hand, were mainly concerned with clues that indicated their place within the doctor-patient relationship. Did the doctor make them feel comfortable? Did the doctor seem like he or she was in a hurry? Did the doctor put them at ease? Was the doctor a good listener? Did he or she make eye contact?

Citation: "'How do you know what Aunt Martha looks like?' A video elicitation study exploring tacit clues in doctor-patient interactions," Journal of Evaluation in Clinical Practice, Sept 26, 2011.

Tags:  Medical Care  October 2011  Physical  Wellness 

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Chronic conditions and the importance of your relationship with your care provider (May 2011)

Posted By National Wellness Institute, Sunday, May 1, 2011
Updated: Thursday, December 27, 2012

A new Study from the University of British Columbia found that People with a chronic condition such as diabetes or arthritis may find themselves taking on a more active role in maintaining or improving their own health if there is an ongoing relationship with a primary healthcare (PHC) provider. The study showed that in North America there were specific links between patient reported outcomes and the quality of services provided by their providers. Essentially, the more involved we are in our healthcare, the better we are able to manage our own health!

Tags:  Chronic Conditions  May 2011  Medical Care  Physical  Social 

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Creating a Family Medical History (November 2010)

Posted By National Wellness Institute, Monday, November 1, 2010
Updated: Friday, December 28, 2012

Some things about your family you would rather keep private while other facts and stories are told year after year at family gatherings. One thing most families don't talk about is their medical histories. This isn't a topic most bring up at the supper table but maybe it ought to be. Many disorders and diseases are caused by, or related to, genetics. Finding out information like what kind of cancer did Great Aunt Phyllis die from might be very important.

Gathering a family medical tree is a good idea for any family. Discussing such matters might not be fun at the time, but when all is said and done everyone will benefit.

The main thing to look for when talking to family members about their medical history are diseases or disorders that have occurred during their life. Family medical history is also very helpful to doctors. Doctors use this to assess an individual's risk of diseases, recommend treatments or daily lifestyle changes, determine what kind and when screening tests are needed, identify a condition that might otherwise be ruled out, identify other family members who might be at risk, and assess the likelihood of passing conditions on to children.

Here are five easy steps to compiling a family medical tree.

  1. Make a list of all medications and doctors that your immediate family has.
  2. Talk and list all significant conditions that your family members have or have had in the past. Also, mention treatments and results.
  3. Every time you go to the doctor make sure to write down the information. This way your kids won't have any questions in the future and keeps your log up to date.
  4. Go to your family's doctor office and see what information they have on file.
  5. Make sure to organize information well so generations to come will be able to find the information easily.

Compiling a medical history for your family may be an uncomfortable task but could save someone's life in the long run. Knowing your family history can help you and your doctors make better decisions and may lead to a healthier life!

By Jackie Lutze, NWI Intern

Tags:  Family  Medical Care  November 2010  Physical 

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