Wrong Diagnoses, Wrongful Deaths   

The increasing incidence of wrong medical diagnosis leading to untimely deaths has become a cause for great concern in Nigeria

In 2006, when Chief Gani Fawehinmi first noticed signs of the ailment he eventually died of, he sought help in a Nigerian hospital, where he was told he was suffering from a heart-related disease. After undergoing treatment for that condition for about one year with no sign of improvement, Afusat Oni, the activistís second daughter, who is a medical doctor, was alarmed and protested to his doctors. Telling them of her conviction that her father was suffering from something other than heart disease, she complained that the medications meant for heart failure were adversely affecting his breathing. But the doctors insisted that it was heart disease. Worried by the prolonged treatment that was worsening Ganiís condition, his family, in January 2007, took him to Royal Marsden Specialist Cancer Hospital, England, where he was properly diagnosed of lung cancer. By then, however, the cancer had reached stage three-B malignancy, a step away from death. No doubt, Fawehinmi would have lived longer than 5 September 2009 if the lung cancer had been correctly diagnosed in Nigeria and treatment commenced earlier.

Painful as Ganiís death was, misdiagnosis of serious ailments, sometimes result to death, this phenomenon is not an uncommon in Nigeria. In many cases, the error is not detected. But even when it is, the ailment may be irredeemable, as in Ganiís  case, the medication taken for the wrongly diagnosed condition would have taken a deadly toll.

Recently,  Ashabi Korede Emiola, a 51-year-old woman, suffered prolonged bouts of headache.  Members of her family administered all kinds of analgesic and were taking her from hospital to hospital. The first hospital diagnosed typhoid. In search of cure, she was taken to another hospital, where she was diagnosed of typhoid. While she was on medications, her situation showed no sign of improvement. Emiola was later taken to the third hospital on Victoria Island, where she had series of laboratory tests. The Magnetic Resonance Spectroscopy, (MRS) scan also failed to pick the primary cause of the headache. She was eventually diagnosed to have suffered from migraine.

She was given analgesic for a week, which came with a temporal relief. The headache got worse and she slipped into unconsciousness. Immediately, a laboratory test was conducted on her, which showed that the blood vessels in her brain had burst. This was the cause of the persistent headache. which eventually killed her. Her death was apparently the result of wrong diagnosis, i.e. late detection of brain hemorrhage.

Dr. Abiola Ogundeji, a consultant with Mainland Hospital, Yaba, Lagos, described misdiagnosis as ìwrong, inaccurate or incomplete diagnosisññand consequently treatmentññof a disease, injury, syndrome, behaviour, infection or other ailment. Some disease conditions can be over-diagnosed, under-diagnosed or overlooked, while some may be difficult to diagnose early. Unfortunately, some patients are victims of medical misdiagnoses that can lead to further health complications or even death.î

Physicians and other medical personnel are often regarded as infallible when it comes to diagnosing patientsí physical or mental problem and keeping them healthy. This is not surprising as they are highly trained and experienced in their practice, and patients expect them to be able to properly assess and diagnose their conditions quickly and accurately.

But sometimes misdiagnosis can occur as a result of a single flaw or instance of carelessness within a healthcare process; a costly one without redemption.

Classifying misdiagnosis and its possible causes, Dr. Rotimi Adesanya, Senior Medical Officer with Otunba Tunwase National Paediatric Centre, Ijebu-Ode, said misdiagnosis could arise from technical or clinical error, or sometimes a combination of both. Any can lead to totally wrong diagnosis, partial diagnosis, delayed diagnosis, identification of the wrong subtype of a disease, failure to diagnose complications associated with a diagnosed disease, failure to diagnose an underlying disease which has caused a diagnosed disease, failure to diagnose a disease related to a diagnosed disease, or failure to diagnose a disease caused by medication used to treat another disease.

According to Adesanya, misdiagnosis typically occurs due to cognitive error, that is, failure to consider all likely diagnoses. He added that with the exponential increase in biomedical knowledge, it is humanly impossible for a clinician to remember the various symptoms and signs associated with all diagnostic possibilities. ëëThe breadth and depth of knowledge associated with more than 20,000 diagnoses can lead to cognitive and diagnostic errors that are difficult to measure. Unlike most medical errors, which are usually errors of commission, diagnosis errors are usually errors of omission and therefore, are difficult to identify. Wrong laboratory test, for example, leads to wrong treatment , wrong management of a disease condition and untimely death,î he informed.

According to Mr. Ibiyinka Roluga, a laboratory scientist, ìLaboratory tests and investigations are carried out to assist the medical practitioner get to the root of the matter in the diagnosis procedure. In this wise, prompt diagnosis with required laboratory investigation and subsequent treatment can slow down or even eliminate an infirmity from the body. However, when misdiagnosis arises from clinical or technical error, the patient can suffer traumatic consequences because the condition is allowed to fester or grow.

It is difficult to accurately report how many misdiagnoses cases actually occur every year in Nigeria because many go unreported and many are even unrecognised. Some statistics estimate that as many as 20 per cent of deadly illnesses are misdiagnosed. As a result, the patient and the patientís family can be left with extreme medical expenses, pain and suffering.

What exactly causes such grave error? Dr. Adesanya pointed out that no one is an embodiment of  knowledge. ìThe field of medicine is very broad and complex. No doctor can claim to know every area of medicine there is. It is therefore important that when a physician is trying to determine what is ailing his patient, he refer the patient to another medical professional who may be a specialist or have a certain expertise. Failing to do so may result in a dangerous disease or rare disorder going undetected. Failure to refer is life jeopardised,î he warned.

In the same vein, Dr. Ogundeji suggested that misdiagnosis can result from ìpremature closureî, that is, doctors jumping to conclusion too quickly without considering all the possibilities that could lead to a particular ailment. Another contributory factor is when a patient delays in reporting the symptoms of a condition before seeking treatment from a doctor. This makes it difficult to detect the underlying causes of the condition. Yet another factor is the failure of a patient predisposed to an ailment to undergo regular medical check-up. Fear, too, can lead to misdiagnosis. That is, some patients may continually fret about illnesses when there is actually nothing wrong with them. Such people are called hypochondriacs. This condition can be triggered by the patientís closeness to someone afflicted by an ailment and he/she begins to imagine having similar symptoms. ìOccasionally a patient who is actually disease-free will be falsely diagnosed with a condition that they donít really have. This can be dangerous because medicines and other treatment that may be given to treat the false illness can cause harm to a healthy patient,î Ogundeji explained.

Arrogance on the part of a doctor can also lead to misdiagnosis. The experience of a 54-year-old journalist succintly explains this flaw. Hear him: ìAbout two years ago, I went to a private clinic complaining about incessant urination, tiredness and a sharp pain just underneath my right armpit, in the pancreas region. Knowing that doctors resent patients engaging in self-diagnosis, I refrained from telling the fairly young doctor that my research on the Internet suggested diabetes. But when he was spending too much time suggesting that my frequent urination was caused by the cold weather which did not encourage retention of water in the body and ascribed my tiredness and chest pain to undue exertion, I  suggested diabetes. Immediately, he flared up:  ëAre you a doctor? What do you know about medicine? Why did you come here if you already know what ails you?í, threatening to send me out of the hospital.

I had to restrain myself from losing my temper, smiled but insisted on undergoing diagnostic test, a request that he promptly rejected on the ground that it would amount to me teaching him his job. At this juncture I also lost my temper and engaged him in a shouting match. The noise attracted another doctor, a senior colleague of his, who came in, placated him and suggested that a diagnostic test be done to put my mind at rest. As it turned out, I tested positive to diabetes.

Misdiagnosis can happen in a crowded hospital or in a small family practice. However, a research indicates a prevalence of misdiagnosis in the emergency rooms, where complex decision making is paired with stress. Misleading or wrong laboratory result by unqualified laboratory scientists as well as the use of expired reagents and kits, collecting samples in wrong receptacles and error in interpretation of laboratory results also lead to misdiagnosis, said Mr. Roluga.

So, how can misdiagnosis be eradicated? All the doctors and laboratory scientists who spoke with this magazine were in agreement that even in the best of climes, where diagnostic facilities are top grade, wrong diagnosis occasionally occurs. But the incidence can be drastically reduced if medical laboratory centres, both private and in government hospitals, are properly monitored to ensure they meet the required  standard in terms of staff and equipment. But what would really make medical scientists more alive to their responsibilities, according to Mr. Kehinde Rufai, a United States-based laboratory technician, is applying appropriate sanctions to negligent personnel. ìThere is a tendency for such personnel to be lackadaisical in the performance of their duties when they know that the error would be treated as a collective failure. And then, many diagnostic centres are mere commercial centres, with money making placed above human safety, he said.

Dr. Ogundeji called on patients to also participate in the diagnosis process. This can be done by asking the doctor questions, getting a second opinion even when the diagnosis seems apparently correct, and conducting personal research on the information provided by the doctor. Above all, he advised, individuals need to go for regular medical check-up for early detection of any disease, patronise standard hospitals and laboratory centres to prevent their conditions from being misdiagnosed.