The inside scoop only a physician could tell you.

Medical privacy is very important in medicine and as doctors keep your problems confidential, they often also keep their problems a secret to the outside world.

Here are 5 secrets doctors don’t want to reveal and how knowing about them can protect you:

Secret # 1:

Doctors often order medical tests, but they sometimes forget to look at the test results or they overlook suspicious details.

An example is Mark who went to see his doctor for a productive cough for the last 3 weeks. His doctor ordered a chest X-Ray to rule out pneumonia.  The radiologist commented that Mark’s lungs were clear, that there was no pneumonia, but he noticed at the bottom of the X-Ray, a suspicious area in Mark’s liver. He recommended an abdominal CT scan. Mark’s doctor only paid attention to the fact that there was no pneumonia and told Mark not to worry.  He gave Mark a treatment of antibiotics which resolved Mark’s cough.  One year later, Mark came in his doctor’s office for abdominal pain.  An abdominal ultrasound revealed a large liver mass which turned out to be a metastasis from colon cancer.  The cancer was too advanced, and Mark couldn’t be saved.  This was unfortunate because Mark’s doctor could have kept Mark alive by reading the lung X-Ray report thoroughly and by ordering an abdominal CT scan one year prior while the liver metastasis was still small and cancer still treatable.

Similar cases are not infrequent: In 2009, L.P. Casilino (Cornell Medical College in NY) and colleagues found (Archives of Internal Medicine) that after reviewing the medical records of 5434 patients aged 50 to 69, physicians failed to inform patients 7.1% of the time.

How can you prevent this from happening to you?

Always request a copy of all your reports especially your blood test results and your radiology reports (plain X-Rays, CT scans, MRIs, etc.).  Read the results yourself thoroughly and don’t be shy about asking your doctor questions if something seems abnormal.  If you have any doubt, run the results by another doctor to make sure that all that is abnormal is attended to.

Secret # 2:

Even the best doctor can make a mistake in treatment, prescribing the wrong medication or the wrong dose of the right medication.  This is especially true in hospitals.

Giampaolo P. Velo of Verona University Hospital in Italy writes in the 2009 British Journal of Clinical Pharmacology that medication errors are common in general practice and in hospitals.  Velo mentions in the article that the range of errors attributable to junior doctors can vary from 2 to 514 per 1000 prescriptions and from 4.2% to 82 % of patients.

Henriksen and colleagues describe that in Denmark in the first 6 months of 2014, there were 147 mistakes in the prescription of anticoagulants (most often the dose was too high).  Out of those 147 mistakes, 7 ended in the death of the patient (who most often bled to death) and 83 gave rise to serious problems.  Henriksen points out that most medications errors happen when there is a hospital admission, a hospital discharge, or surgery.

How can you prevent a medication mistake from happening to you?

Check with your pharmacist that the medication prescribed by your doctor is for your condition and that the dose prescribed is appropriate, especially if you are just discharged from a hospital.  If you have any doubt, don’t hesitate to give your physician a call or to get a second medical opinion.

Secret # 3:

Even the best doctor can make a mistake in diagnosis:

Here is an example: Mary went to see her physician for acute diarrhea that had started the week prior. Her physician diagnosed an infectious gastro-enteritis and gave her Imodium and Cipro. Despite this treatment, Mary’s diarrhea continued for several weeks, completely debilitating her. Desperate, Mary searched on the internet for the possible causes of diarrhea. She found that Magnesium could give diarrhea…. And she was taking high doses of Magnesium. Actually, looking back on what happened, Mary realized that her diarrhea had started just a few days after her first Magnesium intake (which she was taking to decrease her anxiety). She decided to stop taking Magnesium and within a few days, her diarrhea resolved. Her physician had forgotten to ask her if she was taking any supplements and had made the wrong diagnosis of infectious gastro-enteritis when in fact she was just having a side-effect from the Magnesium she was ingesting.

Mistakes in diagnosis are common. Doctors are pressed for time and when they see 30 to 40 patients a day are prone to make mistakes.

How do you prevent a mistake in diagnosis?

When your symptom continues for longer than you think it should, do your own research on the Internet, go back to see your physician and/or seek a second medical opinion. When your body tells you there is something wrong with it, trust what your body says.

Secret # 4:

Some doctors will not know about the latest research or about the best treatment for your condition:

Here is my own example: The last few months, I have had incredible pain in my right ear when traveling by plane and landing. I went to see my ENT (Ear, Nose, and Throat) physician who diagnosed a Eustachian tube problem and prescribed a steroid nasal spray for everyday use. As the problem didn’t improve and I had to take an average of 4 flights per month (over 44 flights per year) I went to see another ENT who prescribed a high dose of an oral steroid to take before each flight. This meant that I had to take a high dose of steroid at least 44 days a year with potentially serious side effects, such as stomach inflammation, osteoporosis, and cataract. Unsatisfied with that answer, I went to see 3 more ENT in the USA and in Paris, France. Two of them (one in the USA and one in France) confirmed that the best way to resolve my problem was to take a high dose of steroid before each flight, the third physician (in France) recommended that, during landing, I use a little mechanical device invented by another ENT physician. I ordered that device, which is a pressure equalizer (it has a small pump that sucks the air out of the ear canal) used at the first sign of ear pain when landing. As soon as I used the new device, my ear pain disappeared. I had no need for oral steroid with heavy side-effects.

How can you find the best treatment for your condition?

It is always advisable to get a second or even a third opinion (and in my case, fourth and fifth opinion) if you are not happy with the first one. It’s impossible for any doctor to know all the latest treatments. If the treatment you are taking for your condition doesn’t satisfy you completely, look for alternative answers. Every week new treatments are discovered and approved by the FDA. Some doctors will know about them, while others won’t. My advice is to continue exploring options until you are completely satisfied.

Secret # 5:

A lot of doctors are very stressed out and are sometimes burnt out, depressed and suicidal, which can lead to low professionalism.

Lisa Rotenstein, MD, MBA, and colleagues (JAMA September 2018) extracted burnout prevalence data from 182 studies involving 109 628 physicians in 45 countries between 2001 and 2018. Rotenstein found that 72% of physicians had emotional exhaustion and 67 % had overall burnout.

Maria Panagioti, PhD and Colleagues, published in JAMA Internal Medicine in 2018 a meta-analysis of 47 studies on 42 473 physicians aged 27 to 53 and found that “burn-out is associated with 2-fold increased odds of unsafe care, unprofessional behaviors, and low patient satisfaction.” This link was seen more in residents and in less than 5 years post-residency physicians.

Burnout and emotional exhaustion can lead to depression which can lead to suicide especially since physicians have easy access to medications.

Louise B Andrew, MD, JD writes in 2018 that physicians have one of the highest risks of dying from suicide despite having a lower mortality risk from cancer and heart disease relative to the general population. L. Andrew estimates 300 to 400 suicides by physicians per year, suicide being, after accidents, the most common cause of death among medical students.

How can you stop a burnt-out physician from giving you unsafe care?

Be aware that you only have 10 to 15 minutes with your physician (sometimes only 5 minutes) so be on time for your office visit. Then, tell your physician in one sentence what you are coming in for (this should include when your new symptom started, how fast the symptom got worse and what other symptoms are associated with your malady). Also, come prepared with the names and doses of all the medications you are taking. If you have questions for the physician, write them down in advance of the appointment. Preparing thoroughly for each appointment will allow your doctor to be more efficient and consequently to relax, de-stress and take excellent care of you.