Posted on June 11, 2009 - by Venik

Buy a Microscope

A rather sad story on CNN tells us about a teenage girl from Washington who for many years has been suffering from an undiagnosed chronic bowel inflammation. For eight years she suffered from severe stomach pain and other serious symptoms, but her doctors were unable to identify the decease.  To make the long story short, the girl used a microscope in her science class to analyze a sample of her intestinal tissue and spotted a granuloma – an area of inflamed tissue consisting of immune cells – that she identified with the help of her science teacher and Google. This was the same tissue sample that was collected and analyzed by her doctors, who failed to detect the inflammation.

The finding allowed the doctors to diagnose the girl’s condition as the Chrohn’s disease – an incurable but manageable form of inflammatory bowel decease. The earlier this condition is diagnosed, the easier it is to manage its symptoms. The girl suffered for eight years because of all the lazy morons posing as her doctors over the years, not one bothered to spend more than a few seconds analyzing biopsy results. Valuable time was lost and now the disease is much more difficult to control.

Unprofessional doctors are all too common. It is a statistical fact that most medical mistakes occur at the diagnostic stage. The most common cause of such mistakes is unwillingness on the part of the diagnostician to invest the necessary time and effort to analyze test results. The case with this Washington girl is by no means uncommon. What annoyed me about this story were the comments by two doctors interviewed by CNN. Consider these two opinions:

Crohn’s disease is often misdiagnosed or diagnosed very late, says Dr. Corey Siegel, director of the Inflammatory Bowel Disease Center at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. “Granulomas are oftentimes very hard to find and not always even present at all,” Siegel said. “I commend Jessica for her meticulous work.”

Pathologists also sometimes miss important findings for other diseases, says Dr. Mark Graber, chief of the medical service at the Northport VA Medical Center in New York.

“This story carries a valuable lesson about how errors are found. It’s very often by ‘fresh eyes,’ just like in Jessica’s case,” he said. “Some specialty centers, recognizing the reality of perceptual error and the power of a second independent reading, are now requiring second reviews on certain types of smears and pathology specimens.”

As you see, medical culture in the US is such that many doctors are unwilling to admit obvious mistakes – even those made by others. When an experienced pathologist looks at a tissue sample and declares it healthy and then another pathologists analyzes the same sample and finds an inflammation, this would be a good illustration of Dr. Graber’s “fresh eyes” theory or Dr. Siegel’s “too hard to diagnose” excuse. On the other hand, when a tissue sample is pronounced decease-free by a pathologist, who is later proven wrong by a teenager with no medical training, using a school microscope and a Web search engine, then we are dealing with something more than a simple difference in perception.

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