Why Do Doctors Miss Diagnoses?                                                     James Chin-Ti Lin, M.D.


    How to answer this question, either politically correct or politically incorrect, can be very catchy or touchy, in order for commentators
    to continue their survival.

    Off and on, we have heard someone including many media-catching celebrities who complained of their doctors’ missing a
    diagnosis for certain cancer or disease. Indeed, such occurrences are very unfortunate in the reality of life; they deserve sympathy,
    which unfortunately and usually offers no meaningful help to realistically correct or modify the course of medical care.  Naturally, the
    news especially those are around a celebrity will become a favorable play in a media-chasing circuit, either to chase the truth or to
    elaborate or exaggerate the facts.  Those to chase the truth tend to be politically incorrect and publicly condemned except there is a
    strong social or political power behind their back; those to exaggerate facts tend to be politically correct and, usually, warmly
    welcomed by the public.

    Despite the presence of such an unresolved medical and social chaos, how can we give this question a fair answer, neither in favor
    of patients nor medical professionals? My intent to answer this question is absolutely not in the position to defend medical
    professionals or to sympathize patients.  Instead, I intend to uncover the very truth of the unfortunate situations with a hope to ease
    the upset of the patients as well as to urge the emergence of humbleness from medical professionals.

    To explore the truth of the answer to this question, it is reasonable to look into this question from two directions: 1. what is a
    disease? and 2. how can we solve the dissatisfaction of life?

    First, what is a disease anyway? As the truth of any event of life, a disease represents itself a process of full spectrum. At its very
    early stage, the symptoms or signs of a disease can be very obscure and elusive. As a result, patients can be very confused and
    uncertain about what they feel; medical professionals can be in a similar mental state about what they think and consider for a
    diagnosis. Due to the presence of the reality of low degree of symptoms or signs, less possibility to catch an attention either by
    patients or medical professionals, and high degree of uncertainty and confusion, the accuracy to make a diagnosis at disease early
    stage will be low.  Gradually, as a disease advances, the disease-related symptoms or signs become more constant and obvious;
    consequently, more alerts and attention to something serious or real will be generated and guarded. At this stage of disease, the
    possibility to make a correct diagnosis will be higher and higher.  While a disease further advances, the clinical picture of a disease
    will, sooner or later, become more full-blown so that more people, either patients or medical professionals, become able and much
    easier to realize the truth of severity of a disease; of course, at this stage of disease, the accuracy of making a diagnosis will be
    higher and reach its highest level close to 100%.  

    Due to the nature of a disease presenting a process of full spectrum as just described, the doctors who attend the patients at the
    early stage of a disease are more likely to miss a diagnosis and be blamed as a poorly qualified or bad doctor. At the late stage of a
    disease, making a diagnosis becomes easier and easier although an accuracy of 100% to diagnose a disease may be still
    impossible in some cases. Generally speaking, the doctors who attend and confirm a diagnosis will more likely earn a high praise
    from patients, families, and friends alike as a wonderful, capable, good doctor.

    How true is it to use this situation to differentiate the doctors as good or bad?  Conceivably, the doctor saw the patients for the first
    time at their early stage of disease could be most qualified and smartest despite he missed the diagnosis of a serious disease.  
    Conversely, the doctor who makes a diagnosis at the latest stage of disease could be least qualified and dumbest despite he
    made a diagnosis.  This is largely due to the public unwillingness to take such a reality of disease presentation and the limitation of
    medicine into consideration because of the following factors: 1. there is a lot of money to make by some professionals, and 2. to be
    politically correct, the courage to face and reveal the truth and facts of life is eroded and fades away.  At this moment, I would like to
    make clear that I do not intend to side with patients or medical professionals but to take the truths and facts of life into
    consideration. In fact, we need to realize that, in life, perfection would and will never be but perfecting should be. That is why it is
    important to define the reasonable standards of practice under certain circumstances in consideration of time and location.

    Second, let us explore how we can resolve dissatisfaction of life. Generally speaking, to reasonably reach an answer to this
    question, it is logical to understand: 1. who are you? , 2. whom or what is someone or something that you are unhappy with?, and 3.
    what is the real face or feature of someone or something that made or has made you unhappy?

    Who are you? Of no doubt, you are the accumulation of your own past including the way you were genetically born, you were raised
    up in family, you were educated publicly or privately, and you have lived and experienced. Saying in another way, everything that has
    happened to you spiritually and physically in life will always pile up in your life, and sooner or later, will reflect at certain points of your
    life.  That is why it is absolutely important to make sure everything you do in life always leading to self-preservation, which will give
    you the best possible opportunity to look nicer, feel better, and live longer. Minimally, every person should adopt the spirit and
    practice of car ownership in order to make his car look nicer, run better, and last longer.

    Whom or what is someone or something that made or has made you unhappy? A disease is a part of life; it is a merciless power to
    force us to move toward the end of life in addition to the silent power from the undesirable ill effects of aging process, which we
    unavoidably dislike. Within the question of “how come my doctor miss my diagnosis?”, it is clear you are not happy with the failure of
    your doctors to give you a correct diagnosis at early stage of a disease and with your subsequent loss of opportunity to receive a
    timely treatment.  Should you forgive your doctor? Yes or no. That depends on how you understand what a disease is, how difficult it
    is to make a diagnosis at the early stage of a disease, and how gracious you are in understanding the humanity from the standpoint
    of patients and medical professionals alike.

    So, finally, we need to explore: what is the real face of someone or something that made or has made you unhappy? Clearly, that is
    you, doctor, disease, and life. A certain depth understanding in you, your doctor, your disease, and the reality of life will forge a fair
    and gracious understanding and forgiveness for you and your doctor. Hopefully, we all are able to work together in a hope to fulfill
    the contents of life we deserve to its fullest.

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