Preamble:
“The beginning of health is to know the disease”-Spanish proverb. And to know the disease it must be diagnosed. Medicine is an incomplete science. This is why there is intensive research with the objective of discovering new methods to identify different illnesses. The practice of medicine must have evolved from what is considered today to be witchcraft. Objective evidence of surgical treatment dates back to the Neolithic times(Later part of Stone Age) when trephining (Drilling a hole into human skull) was practiced, perhaps to provide an exit for evil spirits from the minds of the affected; it was actually to relieve pressure from the brain. Trephined skulls have been found widely dispersed throughout the world, giving evidence that this was not an uncommon operation of the prehistoric era. According to recorded history, the first written evidence of surgical practice was inscribed on a stone near Babylon (South of Baghdad, Iraq) about 2000 BC. It listed a series of regulations and penalties now known as The Code of Hammurabi. By the time of Hippocrates (the father of medicine), about 400 BC, a great deal of knowledge had accumulated concerning such conditions as fractures, dislocations, wounds and diseases. Some historical perspectives tell us that Chinese doctors, as far back as 4000 BC, employed what I call The Rule of The Tongue (where diseases of internal organs such as kidney or heart and infectious diseases reflect on the tongue by changing its colour.)
Throughout the history of mankind, before the beginning of the 19th century, advances in the practice of medicine and surgery were regrettably slow. Some of the factors that caused this were superstition as well as religious and mystical beliefs. For example, we learn that the first surgeon that performed autopsy in Italy to retrospectively diagnose the cause of death was publicly executed for interfering with a departed soul. We are all familiar with existing resistance to blood transfusion of some religious persuasions. For example, The Grail Message teaches that the spirit forms the human blood: “If a different blood group was used in the case of blood transfusion, then the soul living in such a body would find itself prevented from fully developing its volition, would perhaps be entirely cut off from it because with the blood of different composition the radiation also changes and is then no longer adapted to the soul”. Blood transfusions from one human to another was practiced in the early part of 19th century with success but not without severe and fatal reactions sometimes due to incompatibilities. However, with the monumental discovery of the ABO red cell system and the Rhesus factor (Rh antigen) by Karl Landsteiner and Alexander Wiener in 1900 and 1940 respectively the problem of post transfusion reactions due to incompatibility has become a thing of the past because blood is now matched for ABO and Rh antigen for both donor and recipient.
Most surgeons up to and including the time of Ambroise Pare in the 16th century became famous by caring for the injured during wartime. However, their practice must have been rather depressing since approximately three out of every four soldiers injured in the battle field died, primarily from haemorrhage and sepsis. Infection continues to be the leading cause of disease and death in both peace and war times. Because of the present high technological pitch of diagnostics and therapeutics, the very attempt to diagnose and treat one illness may produce another, be it through side-effects or iatrogenesis (illness caused by medical examination or treatment) for example infection of prosthetic implants.
Classification of misdiagnosis
- Intentional
- Unintentional
Intentional misdiagnosis:
This is malpractice in a nutshell. Some laboratories, particularly in developing countries conduct laboratory tests at times with expired reagents and generate false results that negatively impact on the health of patients. You hear excuses such as the shelf life of the reagents has only expired barely two weeks ago. It is still OK. The technologist would enter in the record book results of tests he/she did not conduct because they are conversant with likely results that would be obtained if the tests are performed. An example of such is what a professor of pathology in Nigeria called “Laboratory typhoid” that laboratory-generated typhoid. The doctor on getting this result justifiably prescribes chloramphenicol because the stool culture stated that salmonella typhi was isolated. The patient spends his hard-earned money to buy a medication that he does not need. Besides, this antibiotic is known to cause bone marrow depression, aplastic anaemia and inflammation of the optic nerve to mention a few. The bad eggs in some laboratories falsify blood screening tests to justify blood donation and satisfy their monetary indulgence. I happen to know all these when I served as a member of the Nigerian Medical Council delegation charged with the responsibility of inspecting medical laboratories. Wrong microbiology with indiscriminate use of antibiotics can eliminate the commensal flora that are beneficial in our metabolism. The benefits of correct lab results cannot be overemphasized. Lab tests are used to: diagnose or aid in diagnosing a disease, plan a treatment for a disease, evaluate response to treatment and monitor the course of a disease over time. Some lab tests are precise, reliable indicators of specific health problems, while others provide more general information that gives doctors clues to one’s possible health problem e.g. blood sugar to diagnose diabetes or low-density cholesterol (LDL) that aids development of hypertension.
Not long ago a medical doctor in the United States gave a bad reputation to medical practice by operating what CNN reported as breaking news that was later confirmed by one Mike Adams, a forensic research scientist and investigative journalist. This doctor is a Michigan-based Lebanese American oncologist operating a lucrative cancer industry racket with his criminal accomplice-pharmaceutical companies. This doctor is now serving a 45 years prison term since 2015 for intentionally falsely diagnosing and treating cancer in black people, who genetically are vitamin D- deficient, by dosing them with the harmful chemotherapy which absolutely was not needed and billing government insurance companies. It is known that people that are vitamin D3- deficient are more vulnerable to develop cancer because this vitamin is vital in combating cancer.
Unintentional misdiagnosis:
This is caused by faulty diagnostic devices that are not serviced which leads to instrument malfunction, inexperience of some technologists, use of improperly stored specimens such as blood or urine and fake doctors to mention a few. Faulty diagnostic machine (for example Enzyme Linked Immunosorbent Assay (ELISA) machine can generate wrong and stigmatizing results such as HIV positive. Asymptomatic diseases, such as “silent diseases”, “silent carriers” or diseases that disguise their symptoms can also cause misdiagnosis.
A diagnostic device can be an in-vitro or imaging tool that provides information that is essential for safe and effective use of a corresponding therapeutic product. You can imagine the results one can get from a malfunctioning oximeter, ECG machine or blood pressure monitor. You would not know the amount of oxygen in the body or the function of the heart or the true level of your blood pressure. Classical examples of “silent carriers” of disease are patients with HIV and Hepatitis C. They are not easily diagnosed because they could be asymptomatic. Non-diagnosis is as bad as misdiagnosis. Such diseases are now being diagnosed with what is called stimmunology technique. An example of a disease that disguises its symptoms is cervical cancer. This cancer ranks fourth most common cancer in women especially in developing countries. There is usually no early warning signs or symptoms. However, at later stages can be confused with menses when it presents with pelvic pain and vaginal bleeding.
Some examples of diseases that are misdiagnosed or underdiagnosed
Diabetes:
About 8.1 million of 29.1 million diabetics (28 %) don’t get diagnosed. Patients won’t realize this until it gets severe enough that they start developing side-effects, like problems with their vision, or numbness in their feet and hands”. (Prof. David Fleming- president, American College of Physicians) This could further result in stroke, retinopathy leading to blindness, kidney failure or gangrene that may require amputation. Often the classical 3Ps- Polyuria (frequent urination); Polydipsia (frequent urge to drink water) and Polyphagia (wanting to eat all the time) are misinterpreted particularly in developing countries. At times you hear statement like “he likes to eat.”
Hypothyroidism:
This is caused by Hashimoto’s Thyroiditis and mimics depression and fibromyalgia according to Dr. Eugene Shapiro. The demographic of people affected are those over 60 years of age, particularly women. Doctors tend to attribute this symptom to under-reactive thyroid caused by “wear and tear” that comes with age.
Appendicitis:
Diagnosis could be easy when classical symptoms of nausea, pain and tenderness around the belly button are present. However, according to Dr. Eugene Shapiro (Deputy Director of investigative Medicine at Yale University, United States) “Some people have an appendix that points backwards instead of forwards in the body, so the symptoms present in a different location.
Lupus or Lupus erythromatosis:
This is a chronic autoimmune condition manifesting as an inflammatory disease when the body’s immune system attacks own tissues and organs. Classical symptoms like a facial rash that resembles the wings of a butterfly unfolding across the cheek do not occur in all cases of lupus. Full physical, blood and urine tests are recommended to aid diagnosis. Otherwise it could be misdiagnosed.
Lyme disease:
Caused by the bacterium Borrelia burgdorferi and transmitted through bite of infected black-legged ticks. Symptoms include fever, fatigue, headache and a characteristic rash called erythema migrans. Often these symptoms do not present themselves. Blood test for Lyme disease antibodies is performed but at times the detection of antibodies can be delayed for weeks and may turn out to be unreliable.
Parkinson’s disease:
This is a chronic and progressive movement disorder caused by the malfunction and death of neurons which produce dopamine-a chemical that sends messages to the part of the brain that controls movement and coordination. It is not known why there is malfunction and death of neurons. There is no cure and lab tests. As the disease progresses the amount of dopamine decreases leading to inability to control movement normally. Often confused with Alzheimer’s disease, stroke, stress and traumatic head injury.
Irritable Bowel Syndrome (IBS):
Difficult to diagnose on the account that there is no real test to prove its existence. IBS is a common condition that affects the large intestine (colon) It causes crampy abdominal pain, bloating gas, diarrhea and at times constipation. Prof. David Fleming suggest what he calls diagnosis by elimination. It is often misdiagnosed because “The devil is in the details”.
Rheumatoid arthritis (RA):
Autoimmune disease caused by the immune system attacking the joints. Synovium (tissue that lines the inside of the joints) thickens, resulting in swelling and pain in and around the joints. Early stages of RA can mimic many other conditions presenting as aches or stiffness in the joints such as degenerating joint disease, osteoarthritis or gout.
Fibromyalgia:
A disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues, depression and anxiety. Symptoms of fibromyalgia can be confused with those of arthritis. Because this condition can also present with digestive problems such as abdominal pain, bloating and constipation it has often been diagnosed as IBS. Fibromyalgia involves what doctors call “medically unexplained symptoms”- a term that doctors use to describe persistent complaints that don’t appear to have an obvious physical cause.
Celiac disease:
Serious genetic autoimmune disorder where the ingestion of gluten (substance present in cereals) leads to damage in the small intestine. The world-wide prevalence is 1 in 100. About 2 and I/2 million Americans are undiagnosed. Symptomatology is confused with that of IBS where you have vomiting, abdominal pain, bloating, anaemia and leg cramps.
Because of the above-mentioned diagnostic inadequacies and challenges, it is therefore advisable that patients go to reputable doctor clinics and laboratories for their health care and if still in doubt to seek a second opinion.
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