Charity Watkins sensed that she was in very bad shape when she began to suffer from exhaustion after the birth of her daughter.
Sometimes Watkins, then 30, had to stand on the stairs to catch his breath. His obstetrician told her that postpartum depression was probably the cause of his weakness and fatigue. When the woman, who is black, complained of a cough, her doctor blamed it on the flu.
About eight weeks after giving birth, she thought she was having a heart attack and her husband took her to the emergency room. After five and a half hours of waiting in a North Carolina hospital, she returned home to breastfeed her baby without being attended to.
When a doctor finally examined Watkins three days later, he immediately noticed that his legs and stomach were swollen, a sign that his body was retaining fluid.
After a chest x-ray, the doctor diagnosed him with heart failure, a serious disease in which the heart becomes too weak and unable to adequately pump oxygen-rich blood to organs throughout the body. The woman spent two weeks in intensive care.
He says that a cardiologist later told him: “We almost lost you.”
Watkins is one of the 12 million adults misdiagnosed each year in the United States.
Researchers found, in a study published Jan. 8 in the scientific journal JAMA Internal Medicine, that nearly 1 in 4 hospitalized patients who died or were transferred to intensive care had been misdiagnosed. Nearly 18% of incorrectly evaluated patients were injured or died.
According to a study published in July in the journal BMJ Quality & Safety, an estimated 795,000 patients die or are permanently disabled each year due to misdiagnosis.
More misdiagnoses among women and minorities
Some patients are more at risk than others.
Women and racial and ethnic minorities have among 20% to 30% more likely to be misdiagnosed than white men, according to Dr. David Newman-Toker, professor of neurology at Johns Hopkins School of Medicine and senior author of the BMJ study.
“It is a significant and inexcusable fact,” he stated.
Researchers consider misdiagnoses to be an urgent public health problem. According to the report, rates range from 1.5% for heart attacks, 17.5% for strokes, and 22.5% for lung cancers.
Weakening of the heart muscle — which caused Watkins’ heart failure — is the most common cause of maternal death between a week and a year after childbirth, and is most common among black women.
Heart failure “should have been No. 1 on the list of possible causes” of Watkins’ symptoms, said Dr. Ronald Wyatt, chief scientific officer and physician-in-chief of the Society for the Improvement of Diagnosis in Medicine, a research group. and nonprofit advocacy.
Maternal mortality for black mothers has increased dramatically in recent years. The United States has the highest rate of developed countries. According to the Centers for Disease Control and Prevention (CDC), non-Hispanic black mothers are 2.6 times more likely to die than non-Hispanic white mothers. More than half of these deaths occur in the year following childbirth.
Research shows that black women with childbirth-related heart failure are often diagnosed later than white women, says Dr. Jennifer Lewey, co-director of the pregnancy and heart disease program at Penn Medicine. That can allow patients to deteriorate further, making them less likely to fully recover and more likely to suffer from weakened hearts for the rest of their lives.
Watkins says the diagnosis changed his life. Doctors advised her “not to have another child or she might need a heart transplant,” she said. Being deprived of the opportunity to be a mother again, she said, “was devastating.”
Racial and gender disparities are widespread. Women and minority patients who suffer heart attacks are more likely than others to be discharged without diagnosis or treatment.
Black people with depression are more likely than others to be misdiagnosed with schizophrenia.
Minorities are less likely than whites to receive an early diagnosis of dementia, which deprives them of the opportunity to receive treatments that work best in the early stages of the disease.
(Doctors report serious problems in the care of pregnant women due to anti-abortion laws. “I had to see my daughter suffer,” said a Latina)
Misdiagnosis is not new. Doctors have been using autopsy studies to estimate the percentage of patients who die with undiagnosed illnesses for more than a century. Although those studies show some improvement over time, life-threatening errors are still too common, despite a variety of sophisticated tools, says Dr. Hardeep Singh, a professor at Baylor College of Medicine who studies ways to improve diagnosis.
“The vast majority of diagnoses can be made by knowing the patient’s history, asking follow-up questions, examining the person and ordering basic tests,” says Singh, who is also a researcher at the Michael E. DeBakey VA Medical Center in Houston. . When we talk to people who have been misdiagnosed, “one of the things we hear over and over again is, ‘the doctor didn’t listen to me.’”
“Racial prejudices” and the health system
Racial disparities in misdiagnoses are sometimes explained by noting that minority patients are less likely to be insured than whites and often lack access to high-quality hospitals. But the picture is more complicated, according to Dr. Monika Goyal, an emergency physician at National Children’s Hospital in Washington, DC, who has documented racial bias in children’s health care.
Goyal and his colleagues found in a 2020 study that Black children with appendicitis were less likely to be correctly diagnosed than their white peers, even when both groups of patients went to the same hospital.
Although few doctors deliberately discriminate against women or minorities, many do so without realizing it.
“Racial prejudices are ingrained in our culture,” says Goyal. “It is important that we all begin to recognize it.”
Demanding schedules, which prevent doctors from spending as much time with patients as they would like, can contribute to diagnostic errors, explained Karen Lutfey Spencer, a professor of health and behavioral sciences at the University of Colorado-Denver. “Doctors are more likely to make biased decisions when they are busy and overworked,” Spencer added. “There are some really smart, well-intentioned people who are being swallowed up in a system that is very unforgiving.”
Doctors make better treatment decisions when they are more certain about a diagnosis, Spencer said.
In one experiment, researchers asked doctors to watch videos of actors pretending to be patients with heart disease or depression, make a diagnosis, and recommend follow-up measures. Doctors felt much more confident evaluating white men than black patients or young women.
“If they were less sure, they were less likely to take action, like asking for evidence,” Spencer says. “If they were less sure, they could wait to prescribe treatment.”
It’s easy to understand why doctors are more confident in diagnosing white men, Spencer says. For more than a century, medical books have illustrated diseases with stereotypical images of white men. Only in 4.5% of them in general medicine manuals do dark-skinned patients appear.
This may help explain why darker-skinned patients are less likely to receive a timely diagnosis of diseases that affect the skin, from cancer to Lyme disease, which causes a red or pink rash in the darkest stages. early infection. Black patients with this condition are much more likely to be diagnosed with something more serious that can cause arthritis and damage the heart. Black people with melanoma are three times more likely than white people to die within five years.
The pandemic helped raise awareness that pulse oximeters — fingertip devices to measure a patient’s pulse and oxygen levels — are less accurate for dark-skinned people. The devices work by shining a light through the skin; its failures have delayed critical care for many black patients.
Seven years after her misdiagnosis, Watkins is an associate professor of social work at North Carolina Central University in Durham, where she studies the psychosocial effects experienced by black mothers who survive severe birth complications.
“Sharing my story is part of my healing,” said Watkins, who speaks to medical groups to help doctors improve their care. “It has helped me take back the power in my life, simply to help others.”
