Tuesday, May 28, 2013

Medical negligence reports grossly exaggerated

By Lukoye Atwoli
Sunday Nation 26 May 2013

Last week, a local newspaper carried a series of stories whose thrust was that medical malpractice was rife in the country and was causing untold suffering and loss of lives in our hospitals. An opinion piece carried during the series indicated that “doctors, pathologists and medical industry players concur that misdiagnosis is running at almost 30 per cent of cases, across both public and private hospitals”.

It was claimed that one in ten patients who suffer medical malpractice die. The writer further made the sensational claim that: “Doctors, it seems, are killing more of us, all the time, than our police and all our criminals put together ever have.”

In my view, the opinion piece did not do justice to a complex problem in the health sector, and only served to increase negative sentiment towards many doctors who are already burdened with an inefficient system.

First, the claim that 30 per cent of all patients are misdiagnosed is not only unsupported by evidence, but is also impossible to ascertain. Not all patients who go to hospital end up dead, and not all patients who die undergo an autopsy. In fact, only difficult cases, or cases where there was no diagnosis or a wrong diagnosis, are likely to end up at a pathologist’s table. It would therefore not be very surprising if there is a higher rate of “misdiagnosis” in this setting. 

Physical exam

Majority of patients visiting our health facilities suffer from conditions that probably do not need any investigation beyond a proper history and physical exam. It is preposterous to claim that when one goes to hospital with a common cold they could be misdiagnosed and end up maimed or dead. All the patients diagnosed with depression or anxiety, and are treated with psychotherapy and medication, are unlikely to end up at a pathologist’s table for an autopsy.

Secondly, the allegation that a tenth of those that suffer malpractice die is premised on the assumption that all those that suffer malpractice are known, and have an opportunity to get a second opinion when still alive, or undergo autopsy if they die. This is simply not true. The author of the piece asserts rather sensationally that there are no statistics in our hospitals, or even at the Medical Board, on such cases. Where she gets her own statistics is therefore suspect.

Sadly, the Saturday Nation also carried an alarmist story about a purported link between a life-saving vaccine against mumps, measles and rubella (MMR) and a pervasive developmental disorder also known as autism. The story was based on discredited research by Andrew Wakefield, whose publication has already been retracted by a prestigious medical journal.

After reading these pieces, a group of my non-doctor friends confronted me and asked me to convince them why they should ever go to hospital again. My answer was simple. 

Risk of dying

Not going to hospital when you’re sick definitely elevates the risk of dying from whatever it is that is bothering you.

Secondly, most doctors you see at hospitals know enough medicine to take care of a majority of the commonest ailments in your vicinity. One is therefore safer taking chances with the doctor than with the untreated illness.

Finally, we must take medical opinions proferred by non-medical personnel with a healthy dose of salt. 

Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association and a senior lecturer at the Moi University’s School of Medicine lukoye@gmail.com; Twitter @LukoyeAtwoli

6 comments:

  1. In my perspective, the viewpoint item did not do rights to a complicated issue in the health industry, and only provided to improve adverse feeling towards many physicians who are already overwhelmed with an ineffective program.

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  3. The articles in the media recently in my view were indicative of an approach to a complicated matter by those who either don't care or those burying their heads in the sand. Doctors have for long been lambasted by all from all manner of angles till I sometimes feel practicing medicine in this country is not worth dying for. I don't need to revisit the points raised by the young striking doctors recently, but sadly, they were right. Till this vital aspect of society is given the attention it deserves, a lot of our resources will continue developing health systems in India et al. as our own system is ridiculed by the very same beneficiaries. The country will also continue losing these professionals (check the numbers of young doctors taking Public Health disciplines and MBA's) at the expense of clinical medicine. I cant blame them, life has to be lived.

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