Medical ineptitude

https://www.washingtonpost.com/health/hospital-misdiagnosis-mistakes-ignored/2020/10/02/7bac2d10-f851-11ea-be57-d00bb9bc632d_story.html

By Steven H. Horowitz
Oct. 4, 2020 at 2:00 p.m. EDT

Steven Horowitz is a retired academic neurologist who continues to teach medical students as an adjunct clinical professor of neurology at the Tufts University School of Medicine. He is also on the teaching faculty of the Maine Medical Center.

A doctor gave me an inept diagnosis for a neurological problem. I should know: I’m a neurologist.

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I felt fine afterward, but within hours I developed neck pain with numbness and tingling radiating down my arms. I went to the emergency department (ED) of an elite medical center two days later, telling the staff that I was a neurologist with suspected cervical (neck) spine disease and possible spinal cord and root compression, a condition in my own specialty. I asked to have a cervical MRI scan performed, plus blood studies to detect a possible spine infection, as I’ve had one before.

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The MRI showed clear-cut spinal cord compression due to arthritis, and a neck mass behind the spinal canal. It was an abscess — a pus collection — but the hospital’s radiologist read it as a blood clot. The blood studies revealed active infection: marked elevations in inflammatory markers, plus increased white blood cells of the “should be concerned” variety. These obvious and dangerous abnormalities were not pursued and I was not informed of them. I spent six hours in the ED, then was discharged and told to follow up with a spine surgeon within two weeks.

Two days later, I traveled home to Maine and reviewed my medical records online. I recognized the severity and complexity of my problem and went to my hospital, was admitted and underwent urgent spine surgery and long-term intravenous antibiotics. Left untreated, these abnormalities might well have caused a catastrophe: I could have become quadriplegic, unable to move my arms and legs or even breathe on my own. My response to the ED visit cannot be expected of the average patient, who would have been in deep trouble.

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In 1999, the Institute of Medicine issued its landmark report, “To Err is Human: Building a Safer Health System,” which estimated that as many as 98,000 hospital deaths a year were caused by medical errors. The report made national headlines and generated much subsequent discussion on the causes and effects of medical errors, and the ethics of transparency and disclosure. In response, many hospitals changed their practices and procedures, but two decades later, as my experience suggests, even the best hospitals and doctors remain resistant to admitting error, in large part because they fear malpractice lawsuits.

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