Imagine being in your prime years and living your best life professionally and personally. Suddenly everything changes when you become sick with an undetermined condition, and the doctors you trust with your life almost destroy it due to misdiagnosis. That was the case for Author and Journalist Susannah Cahalan when her life changed forever and was almost gone forever because of a misdiagnosis. Many people have experienced her story, of when misdiagnosis almost ruins you.
According to an article published by the National Library of Medicine, diagnostic error is often part of the concept of misdiagnosis. Diagnostic error is defined by the Australian Patient Safety Foundation as “a diagnosis that was unintentionally delayed (sufficient information was available earlier), wrong (another diagnosis was made before the correct one), or missed (no diagnosis was ever made), as judged from the eventual appreciation of more definitive information.” It also falls into three categories no-fault errors, system-related errors, and cognitive errors.
Cognitive errors are errors that clinicians tend to make in which, “The causes of these can include inadequate knowledge, poor critical thinking skills, a lack of competency, problems in data gathering, and failing to synthesize information.” This is where Susannah Cahalan’s case comes in. In her book, she experienced her first major blackout with her boyfriend Stephen, she was taken to the hospital. While she was there, she was given a CT scan, a neurological exam, and a blood test.
But there was still nothing they could do, so they discharged her early and recommended she see a neurologist the next day. Feeling confused Stephen states, “You’re letting her go? But you don’t know what’s wrong, and it could happen again. How can you just let her go?” The hospital resident explained their decision saying, “I’m sorry, but seizures are fairly common. Sometimes they just happen and never happen again. but this is an emergency room, and we can’t keep her to see. I’m sorry. My advice is to see a neurologist first thing tomorrow morning.”
As time went on and Susannah’s condition worsened, she and her parents went to visit Dr. Bailey. After asking a series of questions, Dr. Bailey recommends that Susannah should see a psychiatrist to confirm her self-diagnosis for bipolar disorder. Dr. Bailey also reassured Susannah that things would be okay by saying, “…everything looks normal to me. I’m going to draw you up a prescription for Keppra, an anti-seizure medication. Take that, and everything should be fine.” Also, Dr. Bailey explained to Susannah’s mom that her condition is fixable saying, “I think this is very simple. Plain and simple. She’s partying too hard, not sleeping enough, and working too hard. Make sure she doesn’t drink and takes the Keppra I prescribed, and everything should be fine.” Everything would not be fine, as Susannah’s condition worsened.
When her parents confronted Dr. Bailey, he explained that everything was normal. Susannah’s mom snapped in frustration saying, “Well, she’s not normal,” Dr. Bailey defends his diagnostic belief saying, “I know it’s hard to believe about your own daughter. But, really, there’s nothing more I can say. She just has to take the medication and knock off the partying.” Feeling enraged, Susannah’s mom explained her daughter’s symptoms to raise awareness of the situation saying, “These are her symptoms: seizures, insomnia, paranoia, and it’s all just getting worse. I haven’t seen her drink in over a week. She needs to be hospitalized, now. Not tomorrow. Now.” This resonates with another case with a woman named Jessica Barnett. In an article published by the Society to Improve Diagnostic and Medicine, Jessica’s mom explained how she had a medical history of fainting and was diagnosed with epilepsy.
When Jessica was given medication, her mom explained how it didn’t work saying, “The ambulance was always at our house, and we were at the hospital three or four times per year because she kept having episodes,” states Jessica’s mom. “I told our doctors that she wasn’t getting better.”
In situations like these, you see how cognitive errors as well as other medical errors can hurt a patient. Unfortunately, other factors can cause doctors to misdiagnose patients. In an article published by Alabama in Jury Lawyer, one of the reasons for misdiagnosis is overworked physicians saying, “If your healthcare provider makes a diagnosis after incorrectly reading test results or failing to take note of your symptoms due to their fatigue, they could be in breach of their medical duty of care.”
The organization also explained that patients who are misdiagnosed can be given the wrong treatment, which could make their symptoms worsen. Such as the case with Susannah, as voices in her head were blaming the Keppra medication for her deterioration saying, “The damn pills. They’re taking over my body. I’m going crazy. THE KEPPRA. I need it out of my system.” Finally, a miracle happened when Susannah met Dr. Najjar. All it took was Susannah drawing a clock for Dr. Najjar to realize that her condition was inflammation in the brain. Susannah expressed her joy at this discovery saying, “This was finally the clue that everyone was searching for. It didn’t involve fancy machinery or invasive tests; it required only pen and paper.” This would be the beginning of Susannah finally being led to the correct diagnosis of a rare auto-immune disease called anti-NMDA receptor encephalitis.
In conclusion, Susannah Cahalan unfortunately went through an unnecessary experience of medical hell all because of a misdiagnosis that almost ruined her life. Other people unfortunately have been through similar hell due to misdiagnosis, but not everyone got to have a happy ending. There are many ways to avoid misdiagnosis. For doctors, it’s simply updating protocol, gaining more education about illnesses, and updating machinery tools. For the patient, it’s simply asking questions, doing self-research, listening to your body, and being your advocate. These steps are necessary for the improvement of medicine. They are also necessary for the improvement of human development.
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