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Incorrect, delayed, or missed diagnoses have plagued physicians since the beginning of time. The result may be significant patient harm and medical resources wasted as the majority of all primary care physicians surveyed report that an average of five percent of their patients come under the category of “difficult to diagnose.” The more the experience of the physician, the less the diagnostic difficulty reported. As many as 20 percent of physicians report that inadequate knowledge was the main cognitive factor involved in failing to diagnose. Other factors include insufficient time to adequately reflect on diagnostically difficult patients, and inadequate time to acquire a careful medical history and perform a thorough physical examination; a situation which will only worsen as the primary care physician shortage is about to be compounded by an influx of patients due to the new Patient Protection and the Affordable Care Act, a bill signed into law to reform the countries healthcare (Obamacare).
This compounding of factors makes it more important than ever for patients to take the time to understand their own symptoms, assist in the zeroing in process of the diagnostic evaluation and collaborate fully with their physician in the sometime twists and turns leading to a final diagnosis. This intense exercise by both physician and patient alike will result in several different outcomes depending upon the complexity of the case:
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Again, in a book with the title CHALLENGING DIAGNOSES, why do I start with the subject of immunity? Because, as it turns out, most challenging diagnoses patients—the bane of primary care physicians and patients—are those who have developed an illness brought about by a malfunctioning immune system. So, if the readers are to have any hope of understanding what may be ailing them, then they must have a basic understanding of the mechanism that is causing their condition and their physician’s frustration in making what is often a very difficult diagnosis to establish. That is why this book must start with a treatise on the immune system
An understanding about the mechanism involved in the etiology of a puzzling illness, and often a chronic one at that, is crucial for any patient to be able to understand, accept and learn to live within its context. And I stress again: in the treatment of these unusual diseases, there is nothing more important than an educated patient working in collaboration with a dedicated physician. It can be a partnership guaranteeing the best possible result.
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