Many people change docs due to perceived mistakes

NEW YORK (Reuters Health) - So you think your doctor has made a mistake? You're not alone.

A new survey of primary care practices in North Carolina shows nearly one in six patients believed their physician had made a wrong diagnosis or a treatment error, and about one in seven said they had changed doctor as a result.

"Patients perceive mistakes in all types of outpatient clinics from primary care to specialty care, eye doctors to dentists, and they often change their doctors because of these perceptions," said Dr. Christine E. Kistler, whose findings are published in the Archives of Internal Medicine.

But Kistler, of the University of North Carolina at Chapel Hill, added that in some cases it didn't appear the doctor had done anything wrong.

"It's possible that the doctor has not explained their plans appropriately and that communication might improve what the patient expects to happen," she told Reuters Health in an e-mail.

One patient with chronic back pain, for instance, reported changing doctor because several medications had failed to work. But chronic back pain may be tough to treat even for the most accomplished doctor, and it is not unusual to go through various treatments before finding one that works.

Although Kistler and colleagues didn't determine if true errors had been made, other cases suggested they had.

For example, one woman said her doctor had wanted to remove her breast due to a swollen lymph node.

"I wanted another opinion," she told the researchers. "I got one, and that doctor sent me for a mammogram and biopsy of the lymph nodes. It turned out I had 'cat scratch fever,'" a bacterial infection.

Indeed, U.S. data published in 1991 suggested as many as 98,000 deaths per year might be due to medical errors. In the new survey, based on almost 1,700 patients at seven clinics, eight percent said they had experienced "a lot" or "severe" harm from the perceived mistake in care.

"Continuing to question and gather information is important for patients," said Kistler, adding that second opinions and information about the normal course of a disease could be helpful.

Dr. Ning Tang, an expert in patient safety at the University of California, San Francisco, said the area has seen little improvement in recent decades.

She called for better data, adding that doctors could do a better job of talking and listening to their patients.

"We certainly do need to improve communication with patients and help them understand what to expect from primary care," said Tang, who wrote an editorial about the new survey.

Earlier national surveys show as many as one-third of Americans believe they or a family member have experienced an error in medical care, she said.

Even if some of the perceived errors really just reflect normal medical practice, they "add extra stress for the patient and damage the relationship that a patient has with his or her physician," Tang told Reuters Health.

She said patients should always ask questions of their doctor if they felt something was awry. But as one patient told researchers in the new survey, doing so can be challenging.

"I never talked to the same doctor again," the patient said. "If I told him, I don't think he would have taken it very well. I think he would have told me that I was wrong again."

If a mistake has in fact occurred, acknowledging it openly may help more than just the patient. Just last month, a study from the University of Michigan Health System suggested that saying "I'm sorry," and offering a compensation, made patients much less likely to file a malpractice lawsuit.

SOURCE: http://link.reuters.com/cug53p and http://link.reuters.com/dug53p Archives of Internal Medicine, September 13, 2010.