Most people, at one time or another, have received an incorrect diagnosis or seen a doctor who's been stumped by their symptoms. Often, it doesn't much matter, since symptoms go away on their own. But misdiagnoses can also cost lives: an estimated 40,000 to 80,000 hospital deaths every year, according to a March paper published in the Journal of the American Medical Association. What's more, 5 percent of autopsies indicate that the real cause of death was a condition that was missed by doctors. One leading reason for such errors? The 18-second rule. "That's the average time it takes for a doctor to interrupt you as you're describing your symptoms," says Jerome Groopman, professor of medicine at Harvard University and author of the best-selling How Doctors Think. "By that point, your doctor has in mind what the answer is, and he or she is probably right about 80 percent of the time—not bad, but not good enough."
So what can you do to increase the odds your own experts will get it right? Groopman, who several years ago dealt with a series of misdiagnoses for his own wrist pain, advises being proactive about being fully heard to help correct potential errors in a doctor's thinking. Here are six secrets he and other crackerjack diagnosticians apply when they're the ones on the examining table.
1. Make sure you can tell your whole story. If your doctor appears to be in a rush and interrupts frequently, you're at greater risk of being misdiagnosed. "In nearly every case, patients are telling their doctors the diagnosis in what they say, so listening to the story is critical for doctors," says Groopman, who was paraphrasing the advice of William Osler, a famous 19th-century diagnostician. After having his wrist examined by one of the most renowned hand surgeons in the United States, Groopman decided to seek another opinion; the doctor had swept in and out of the room "so quickly he could have been on roller skates."
2. Ask your doctor three vital questions. After your doctor comes up with a possible diagnosis, ask: Is there anything in my medical history that doesn't fit with your working hypothesis for what I have? Then follow up with: What else do you think it could possibly be? Both are questions Groopman posed to his own doctors to force them to "think broadly and deeply" about alternative causes for his wrist pain. Finally, you can ask if it's possible that you have more than one thing wrong with you—migraines, say, along with irritable bowel syndrome.
3. Verify any shocking medical test results. About 3 to 5 percent of the time, something goes wrong with a lab test—a vial of blood is contaminated, an imaging test not correctly calibrated, or a tissue biopsy mixed up with another patient's. "I've seen lab mistakes dozens of times," says Robert Wachter, chief of the division of hospital medicine at the University of California, San Francisco Medical Center. "If a patient suddenly becomes anemic or her blood sugar level doubles, I'll run a second test to make sure the first is correct. In fact, I do this whenever I find myself looking at a test result and thinking, 'That's weird.' "
4. Don't discount doctor-patient chemistry. You should feel comfortable conversing with your doctor, and vice versa. "Your doctor should exude a certain warmth and interest in what you have to say," says John Mann, an infectious disease specialist at Johns Hopkins Hospital in Baltimore. "He should ask open-ended questions." Two key ones: How did your symptoms begin? What was going on in your life before you began feeling sick? Mann adds, "I've often said to new patients, 'Let's start with the last time you felt perfectly well and proceed from there.' "
5. Acknowledge your quirks. This can help, says Groopman, if you think your doctor isn't taking your complaints seriously. Acknowledging that you, say, have a high-strung personality, or are a little bit of a hypochondriac, or have no tolerance for pain, can let your doctor know that you have insight into your own emotional state. You can then go on to say, I know I get ________ [fill in the blank] when I'm really stressed out, but this pain feels different, more intense, sharper, less diffuse.
6. Allow for the possibility of uncertainty. Sure, we all want a label for our symptoms, but don't push for a definitive diagnosis when your doctor seems unsure. "I was very happy to hear one surgeon tell me that he didn't know the reason for my wrist pain," says Groopman. "That's an honest answer. You want to be accurately diagnosed, not placated." Better to have a doctor who acknowledges that she doesn't have a clue and then refers you to someone who does than to have one who insists that she's right when she's not.