How deadly can wrong diagnoses get? For those who have gone through it, it is nowhere to be, as it usually spells wrong treatment and graver complications. In this report, Medinat Kanabe explores the stories of some people who have managed to escape the peril of such medical errors and why these things happen.
For seven years of marriage, Mrs Bolanle was childless. But it was not for lack of conception. In those seven years, she had had 21 miscarriages, and all the pregnancies never passed their first trimester. Hers was therefore a case peculiar, yet pitiable. In 2014 however, she got pregnant again; but unlike in the past, the pregnancy progressed into the fourth month, causing her to become hopeful and excited. Perhaps, this would survive, she thought. She began to shop for the baby, but just a week before it clocked five months, she noticed she was spotting and immediately left for the hospital. At the hospital she was told to go in for an urgent evacuation because she had had another miscarriage. Mrs. Bolanle however refused and went home, damning all consequences. Surely, this was a decision she may have to regret, she thought; but how the hell could they tell her to go and evacuate another dead foetus from her womb!
By the next morning, she felt a movement in her tummy. What was that? She thought. She went to the hospital for a scan, and lo and behold, the scan showed that her baby was alive with a strong heartbeat. Now looking back, Mrs Bolanle is glad she disobeyed the doctors that once. “If I had listened to the doctor and gone for an immediate evacuation, they would have taken out my baby. The child I had longed and prayed for, for years.”
Today, her baby is two years old, well and kicking, and a testimony that doctors are not always right.
Like Mrs Bolanle, Mrs Bukola Williams suffered the same fate of wrong diagnoses. She spoke of how she was almost opened up when a doctor diagnosed her with fibroid tumours, when all she was suffering from was appendicitis.
“I was having pains below my abdomen and went to the doctor who told me after checking me that I had fibroid and must be opened up urgently to prevent something more severe. I believed him but decided to seek another doctor’s opinion. The other doctor told me that if it was fibroid, I would have been seeing the signs before then. Nevertheless, he conducted some tests and discovered that all I had was appendicitis. I was treated and became well.”
For 57-year-old Therese, finding a lump in her breast at 52 years was the scariest thing that had ever happened to her. Even though it didn’t cause her any physical pain, the mere fact that it was there, made her utterly uncomfortable. She made an appointment with her doctor, who sent her to see a surgeon.
“The surgeon removed the lump that afternoon, took it to the lab and told me to wait for his call. I didn’t hear from the surgeon after a week, so I called and was told that the result was not out yet. The surgeon called the next week and told me that the result was out and that I had a rare cancer called subcutaneous panniculitis- like T-cell lymphoma. He also told me that the result took a long time because the cancer was so rare that they had to seek a second opinion from another laboratory.
“Although I was having symptoms like night sweats and hot flashes, which were normal for many women at 52, I didn’t think it was menopause that caused the symptoms but the cancer. Well, I was advised to see an oncologist as soon as possible, which I started to prepare for and also began to make my own research.
“When I finally saw the oncologist, he took a look at me and sent me for a CT scan and blood test and both came back positive. He however didn’t say I wasn’t having cancer; rather, he said I would die by the end of the year. He said two laboratories cannot be wrong and said I had to start chemotherapy. I refused to start chemo and continued to live my normal life, until a friend I confided in referred me to another oncologist. I was elated when I learnt that this oncologist was treating a patient with SPTCL. I couldn’t wait to see him. Eventually, the doctor took out time to check me and I was diagnosed with panniculitis an inflammation of fat cells and not cancer.”
Therese lamented that the trauma she went through until that final diagnoses, was one she doesn’t like to relive.
Sunday Ogunola a journalist told this reporter of how his wife was diagnosed of kidney stones instead of ovarian cyst. According to him, “My wife was complaining of pains, so I took her to a very big and respected private hospital in Lagos. There, they put her on admission after diagnosing her of having kidney stones and recommending that she be opened up and operated upon. She was in the hospital for a week, waiting for the doctors to be ready for the operation while I was busy doing my research about kidney stones and other available options opened to us.
“After a while, it occurred to me that I should go for a second opinion, so I took her to a public hospital, where it was discovered that she had ovarian cyst and not kidney stones. She was placed on very strong antibiotics and after a week, she was fine. Up till today, she has not had any pains and I have stopped using that hospital. In fact, anytime I find myself passing by that hospital, I curse them.”
James and joy were lovers for 4 years before they decided to get married. To prevent having a child with the sickle cell anaemia, they went for a blood test which came out okay. The result showed James was AS while Joy was AA genotype, meaning there was no chance of having a child with the disease. They were happy and went ahead to get married. Soon their marriage was blessed with a girl child.
They were very happy but their happiness was cut short, as their baby started falling ill, causing them to become regular visitors at hospitals, until they were asked to conduct a blood test on the child.
The result showed that the baby had the sickle cell anaemia. This came as a shock to James and joy, as they were sure of their genotype and couldn’t imagine how that could have happened. They were advised to go for another blood test to double-check their genotype.
“The new test showed that we were both AS. We went back to the hospital where we first carried out the test and this time, the result showed that both of us were AS. It then dawned on us that the result that was given to us the first time was wrong.
“That wrong diagnosis made us go ahead with our wedding and now we have a child with the sickle cell anaemia. Although the hospital that made the mistake is taking care of the child’s medical bill, we had to go our separate ways to avoid having more children with SS.” James said.
Bayelsa governor to the rescue
Just last month, Governor Seriake Dickson of Bayelsa State opened a multi-billion naira ultra-modern diagnostic centre in Yenagoa, the state capital. According to the governor, this was to fill the yearning gap for world-class diagnostic facilities, following incessant cases of wrong test results in the nation’s medical system.
Dickson singled-out wrong and inaccurate information on patients’ ailments as a major challenge in the health delivery process in the country; but perhaps if the governor knew the enormity of this problem, he would have called on his fellow governors in all the 36 states to follow suit. Many have perpetually lived in pain and regrets following such wrong diagnoses; but those are even the ‘lucky’ ones. Some have been sent to the great beyond for the simple reason that they went to a hospital for treatment. The case of the late human rights lawyer, Chief Gani fawehinmi is still fresh in memory. Many argue that the firebrand activist could probably still be alive, were it not for the fact that he was misdiagnosed and for years, treated for pneumonia, whereas he was indeed suffering from lung cancer.
Laboratory scientist speaks
A laboratory scientist and National Vice President, Guild of Medical Laboratory Directors, Mr Kolawole Oderinde who spoke to The Nation said Medical Laboratory scientists are not supposed to diagnose patients’ ailments, but carry out biological tests through standard procedures to get a valuable result that will assist the doctors in taking final decisions concerning the diagnosis.
Oderinde, who is director at Kings Medical Laboratory, Benin, said “In laboratory practises, the sources of wrong diagnosis starts from personnel. Right from the point of collection of samples, to what we call pre-analytical, analytical and post analytical.
Pre-analytical are those procedures that involve collection of the samples, whether it is collected into the right container, and whether the person collecting the sample understands the request from the doctor.
“The second aspect is the mixing up of one patient’s sample and wrong labelling of patients’ samples. If the doctor knows his work well, he may raise an alarm after seeing the results; but if he is a careless, he may go ahead to treat according to the result in front of him.
“Also if during registration of names, there is a mistake, wrong diagnosis could come up. At the analytical stage, we have to be sure of the right reagent. Here, we ask ourselves if the reagents are of good quality; if they are not expired; if they have been quality controlled or (if they’re the ones that are just imported without proper quality assessment). Wrong, expired reagent can give a wrong result and when you have wrong result, there is wrong diagnosis.”
Said Oderinde, “If for example, you bought a reagent in a part of the country that is known for selling fake and expired products, and the reagent did not pass through NAFDAC or not properly stored; the sellers will definitely play some tricks on you. And when you use such reagents, they give you results that may not be exact. That is why you see that typhoid result is positive for everybody everywhere, even when the person does not have the disease.
“We should also ask ourselves about the calibre of the person conducting the test; is the person well-trained, qualified, and how long they have been practising. Because we find that in some hospitals, they use staff that are not qualified to run their laboratories and they just throw out wrong results. This is why we have the Guild of Medical Laboratory Directors; their job is to find out reasons for wrong diagnoses. If you collect a blood sample and you run HIV test and it is positive and the person goes to another laboratory and it comes out negative, the guild will come in to find out what happened.”
Oderinde observed however that some patients mutilate the results that an authentic laboratory scientist has released. He said, “A patient can come into your lab and tell you he wants to do a full blood count without telling you that he wants to test for HIV. If you give him the result of the full blood count, he will just write HIV negative, even when he knows that he is positive.
“Some patients deliberately want to hide a particular ailment that they have. Some ladies will come to you and request that you do a pregnancy test and write positive even when they know they are not pregnant.
“During the post analytical stage, wrong diagnosis can also come up, because after you have finished running the test, it may not be the scientist that will type the result. If after writing, you give it to your typist to type and he types rubbish and brings it back to you to sign. If you sign without taking another look, the result may go out to the doctor like that and cause wrong diagnosis.
“This is why we tell laboratory scientists to be very careful while doing their jobs; from the first time the patient or samples come in until they leave the laboratory.
A lot depends on the doctor and the facility
A doctor with a private hospital in Lekki area of Lagos State, Ibeauchi Chinasa, who also spoke with The Nation, said by the training of a doctor, most of your diagnosis should be clinical before you go to the laboratory.
He said, “Diagnosis depends on what you get from the patient and what you find on examination and also if you take a good history. After taking a good history, it is expected that you would have done 50 to 90 per cent of your diagnosis; so you then narrow it down to what it could possibly be.”
Chinasa said, “The laboratory test is to confirm the diagnosis, so what the lab test is giving you should be in agreement with what you have initially diagnosed clinically. If not, you will have to do more clinical examinations or go with your clinical diagnosis. Another reason is if you are in doubt, you do a laboratory test to clear your doubt and to rule out what looks like the disease but is actually not the disease.
“Your treatment now depends on your diagnosis. So if you make a good diagnosis, you can treat but treatment should also not be generalised. An example is if two people have malaria, you should not treat them with the same malaria drug because recent medical practise suggests that treatment should be individualised. So the reason Mr A is taking a particular drug may be the reason Mr B may not take the same drug, even if they are suffering from the same thing.”
He argued that “It is important you get the diagnosis right because if you miss your diagnosis, you are most likely to miss your treatment. If you catch the real thing, your treatment will be easy.”
He said, “Wrong diagnosis leads to treatment failure and there are cases where you cannot afford to have treatment failure especially in emergencies (a medical condition that requires immediate medical intervention to prevent complications or death).
“If someone comes in with acute appendicitis; the management fact of appendicitis is immediate surgery, as soon as diagnosis is confirmed. But it is not very easy to make especially in women because in women, there are several structures that occupy the same space as appendicitis and a lot of them can be made acute appendicitis. So by the time you miss out on that diagnosis, it means you have a patient with ruptured appendicitis. Therefore, instead of doing a surgery that will last 30 minutes or 1 hour, you do a loparotomy that will last hours and instead of paying N100, 000 for the surgery, the patient end up spending about N500, 000 to N1m; and that still does not guarantee that the patient will survive.
“Acute appendicitis is known to be notoriously misdiagnosed. Some people will do a surgery for appendicitis on a person whose appendix is okay because of another structure; but treatment failure is what we fear most.
Chinasa however said that it all depends on the training of the doctor an the faclities available “Good facilities are required, whether you are well trained or not, to get the right diagnosis, because wrong diagnosis and treatment can kill the patient you are trying to save.”
For example, there are two types of strokes the haemorrhagic and ischemic stroke. Both of them give the same symptoms and also have a lot of differences. Clinically too, they can be differentiated but if you have a patient with ischemic stroke, there are things you must do immediately. So also if you have a patient with haemorrhagic stroke, there are things you must do immediately.
“If you mistakenly treat a patient for ischemic stroke the way you should treat a patient with haemorrhagic stroke, you are killing the patient. The patient may die in 30minutes. But if you have the facility and you do the right thing fast, the patient will bounce back.”
