June 14, 2012

"Girl, 15, died of tuberculosis after being misdiagnosed with 'lovesickness.'"

In England.
"She found it very distressing he was suggesting she was lovesick for a boy," the girl's father, Sultan Sarag, 43, told Birmingham Coroner's Court.... "He said all the problems were in her head and she should see a psychiatrist or spiritual healer."
Did I say this happened in England?

34 comments:

Rusty said...

National healthcare is AWESOME!
Just think about how well it's going to work HERE!

tim in vermont said...

I spent a month in England one time (Yes, it was England, the Midlands) giving a training and came down with a case of gout. (That's what I get for trying to drink with a bunch of Brits.) I didn't know what it was and the advice I was given was to try heat or cold on it. I plunged my foot into a bucket of hotel ice every day to minimal effect. Got home, got a prescription, the pain was gone in hours and the gout was gone in days...

I was in Australia for a few months working and got food poisoning, was out of commission for a week. The Dr told me they "usually let these things run their course." After a week, I went back and told him "I needed drugs!" He then deigned to write a prescription for me, and I was back at work the next day...

But hey, at least liberals have a clean conscience, and who can put a price on that in mere pain and suffering of others?

Matthew Sablan said...

Sweet, sweet lawsuit is being drafted now.

Bertram Wooster said...

So, how's that National Health Care thing working out for you? What's that you say? Put your teeth in and say it again.

MadisonMan said...

So now everyone she was in contact with has to be tested for TB. Well, ideally.

Not very efficient.

Erika said...

Are we all too uncomfortable to address the elephant in the room, folks?

fleetusa said...

ObamaCare in 10 years.

gerry said...

But, as James Taranto always reminds us, Paul Krugman tells us that the government runs the Brit Health Service, and the government would never let bad things happen...

ndspinelli said...

Consumption! It killed Doc Holliday.

Shanna said...

Are we all too uncomfortable to address the elephant in the room, folks?

I was wondering what the background of the 'it's just lovesickness' doctor was. I don't think they teach that in most medical schools.

Poor girl.

CWJ said...

@Madisonman. Exactly!

But as you suggest, will they? Or will it be sloughed off as too expensive, not part of that population's culture, or some other excuse.

I don't know the details, but one also wonders where the competent doctors might be. Emigrated to the states? Accepting only cash payment patients, or what?

cubanbob said...

NHS at its finest. Of course it didn't occur to these fine doctors to consider a Pakistani girl who developed symptoms after returning from a trip to Pakistan might not have actually contracted a disease that is mostly found in the third world. The article doesn't state it but presumably none of these fine doctors ever actually ordered some blood tests to see if she was having some sort of infection. Perhaps due to some NHS rules. On the other hand had the poor girl seen a doctor that was outside the NHS (they do have private fee for service and private medical insurance in the UK) that doctor probably would have ordered a blood test just to rule things in or out. Its not for nothing that those who can afford private insurance in the UK usually do have it.

Matthew Sablan said...

She, uh, apparently had suffered from TB before. This is actual malpractice. So, it wasn't that big of a stretch either.

edutcher said...

Remember Dr Berwick loves the NHS. And I don't doubt he'll be back if there's a second term.

fleetusa said...

ObamaCare in 10 years.

fleet, that's not 10 years from now -
that's now.

Tim said...

One of the virtues of a nationalized health care system is that it will victimize its proponents too.

Seems they'd rather get "free and bad care for all" than "excellent, paid care for 85% and free care for 15% at the ED."

Downside is, the rest of us will get screwed too.

Christy said...

How 19th century of the Birmingham doctors!

How scary! I've a cousin in a UK hospital now, waiting to deliver and updating Facebook regularly with the latest complication.

george said...

Everyone touts how much money can be saved by emulating other country's health care systems but they never say how this money will be saved. This is how it is done. It is cheaper to diagnose love sickness than to actually treat the poor child.

This is very common in France as well where they have single payer. The husband of a girl I went to high school with has a huge lump on his clavicle where there was no one available to set his bone properly after a bike accident. She has serious depression problems and was prescribed some cheap herbal remedy.

The other thing I learned when working for a Japanese company which is one of the give largest in the world is that when you are ill there you have to pay the doctor under the table since what the government pays them is not enough to cover expenses. This is common in government run systems. If you think about it things are the same here. We all pay taxes for public education but in many places if we want our kids to actually receive an education we have to send them to private schools. Unless you count learning to take to the streets as a mob and demand access to other's resources... then the public schools do a bang up job. Having to pay for things twice is never counted in the expense tally.

Here is one simple, immutable fact --- you get what you pay for --- and if you aren't paying for it yourself you will get whatever some bureaucrat decides is necessary to make his numbers look right.

Petunia said...

The NHS is also very good at sending people with horrible headaches home with medications, and not running CT scans until the stroke, cerebral hemorrhage, or brain tumor has progressed to the point where it is untreatable.

sydney said...

Tim in Vermont,

I was in Australia for a few months working and got food poisoning, was out of commission for a week. The Dr told me they "usually let these things run their course." After a week, I went back and told him "I needed drugs!" He then deigned to write a prescription for me, and I was back at work the next day...

I had a patient who had a similar experience in Iceland. He had a signs and symptoms of a sinus infection. The doctor wouldn't write him a prescription. Told him "All you Americans want is drugs." When he got home and saw me, he had an ear infection. There are arguments to be made for delaying the use of antibiotics in some cases - food poisoning, sinus infections - but at some point sometimes you do need pharmaceutical help.

AllieOop said...

I've never heard such stories coming out of Germany or Singapore, or the Netherlands, or Sweden, Denmark, etc. etc.

Tibore said...

Was Pandit actually a medically trained doctor? I know that sounds like a weird question, but with their National Health Service legitimizing "Complimentary and Alternative Medicine" ("CAM", mostly called "sCAM" on quackwatching and pseudoscience busting sites), it's a question I actually think should be asked.

Now, that said, I do have an issue with the story as reported. Yes, it's just flabbergasting that a doctor would ask about "lovesickness", but read the article: The substantive diagnoses were a viral infection, a "chest infection" (or is the reporter conflating a single thing as two different infections?), "Traveller's Diarrhea"... With those diagnoses, the question should have been whether those were being treated correctly, and when it was obvious she wasn't recovering, was there any further attempt to discover what else might be wrong?

Yes, "Lovesickness" was a stupid path to take. Utterly stupid. It's also a red herring; what was the followup when her condition deteriorated under treatment for the substantive problems (Yes, given the context I'm presuming she was hospitalized)? It's easy to get distracted by the flash of stupidity, but the substance of the problem is found in what they did when the girl deteriorated under care for diarrhea and other infections. As well as why the doctor didn't test for TB again. The core of possible malpractice may lay beyond a single dumb question, and that single dumb question, as stupid as it may be, has the potential from distracting from a deeper problem.

Maybe Pogo can weigh in here. He's got the actual experience in the field, whereas I'm just a layman.

cubanbob said...

The other thing I learned when working for a Japanese company which is one of the give largest in the world is that when you are ill there you have to pay the doctor under the table since what the government pays them is not enough to cover expenses. This is common in government run systems. If you think about it things are the same here. We all pay taxes for public education but in many places if we want our kids to actually receive an education we have to send them to private schools. Unless you count learning to take to the streets as a mob and demand access to other's resources... then the public schools do a bang up job. Having to pay for things twice is never counted in the expense tally.

Amazing how often a parent has to hire a tutor to teach the kid what they didn't learn from the public school teacher. And more often than not, the tutor just happens to be the teacher.

Allie just because you haven't read about incidents in those countries doesn't mean they don't occur. More than likely if if isn't posted in English it isn't picked up here.

Tibore said...

Hmmm... from a Birmingham Mail newspaper article back on May 16th:

"Today, consultant radiologist from City Hospital Dr Claire Keaney said a chest x-ray in October 2010 had shown shadows on Alina’s lungs.

But she said taken with the teen’s symptoms the most likely cause was a lower respiratory chest infection.

However Dr Keaney said if treatment failed to cure Alina’s symptoms TB should have been kept in mind as a secondary diagnosis.

“The TB diagnosis should have been kept in mind,” she told the Birmingham hearing, “and if the patient didn’t respond to treatment a repeat chest x-ray was advised.

“A lack of weight-loss and cough took the diagnosis away from tuberculosis,” she said.

However the hearing also heard Alina, a former pupil of Sparkhill’s Hillock School, had lost weight since returning from Pakistan in August 2010.

She was not diagnosed with TB until her second admission to Birmingham Children’s Hospital in January 2011 shortly before the death."


I'd provide the link, but Google/Blogger doesn't like me and disappears my posts every damn time. I also don't want to add to Professor Althouse's burden of having to approve posts. Just do a Google News search for the girl's name, and you'll find the article.

Tibore said...

Oh, wait, I posted the above for a reason. I'm a layman, so I'm a little confused about how differential diagnoses are pursued. The article I mentioned above had a quote specifically saying "A lack of weight-loss and cough took the diagnosis away from tuberculosis". The question is, how do practitioners deal with symptoms such as this case leading the diagnoses astray? Yes, that's probably 4-plus years of classes and experience to fully answer, but I'm looking for what the general philosophies are about dealing with misleading symptoms and differential diagnoses leading you away from what the problem ultimately is. How do practitioners manage to keep in mind possibilities when data leads them off those alternate possibilities trails? And getting specific: What would be the threshold in a case like this for a doctor to say "You know, the symptoms don't match, but let's test for TB anyway"? Or is there even such a threshold?

Sure, I mentioned Pogo earlier, but that's only because I recall him being a doctor. If anyone else is in the health care field, feel free to speak up. I'd love a bit of education on this.

traditionalguy said...

To avoid damage suits for negligence the MD only has to meet the standard of care of other MDs in the system. And only sewing up scissors or clamps in a patient seems to get another MD to tesitify...not misdiagnosis no matter how obvious in hind sight.

In the Nationalize Health Service, this was competence. What if she was love sick? Your not a MD.

And guess what,today a trend that started in Texas effectively outlaws legal compensation for MD's negligence in most of America.

Synova said...

She managed to see a number of different doctors, some of whom seemed to have reasonable ideas about what might be wrong. Why she didn't follow up with *them*, we don't know.

And the article says, "...one general practitioner..." So did she see more than one of those? Or did they make a mistake reporting and meant, "one, who was a general practitioner" which leaves room for this person to be the one-and-only and functioning as a gate-keeper to the system.

Certainly I understand beyond-nothing about the NHS but I have acquaintances (of the internet sort) who have explained how difficult it is to get medical care if your general practitioner decides you can't possibly be sick. (In her case it was her husband having really bad sleep apnea without being fat.)

The prospect of some single person having the power to keep you from seeing specialists is a rather horrifying one.

Yes, I know, there are lots of people who are professionally "sick" and always think they've got the next exotic thing, my grandmother was one. Stopping that abuse is a super great way to save money.

Unless your thin husband has sleep apnea or your angsty teen daughter doesn't respond to the first three attempts at diagnosis.

Steven said...

Well, Allie, I'm sure your deafness somehow proves something, but probably not what you think it does.

DADvocate said...

Medical errors kill over 250,000 people a year n the U.S. Some of the reasons are as stupid as the one in England.

dbp said...

"In Britain, the government itself runs the hospitals and employs the doctors. We’ve all heard scare stories about how that works in practice; these stories are false."

Paul Krugman

Clorinda said...

I've had some experience with the NHS. I was in for something, and the doctor did write a prescription. I looked at it upside down and said "Ibuprofen?". He said, "Oh, you've heard of it?"

Another time, I went with a friend who had bad knees. It caused her to wear the heels in her shoes down weirdly. She twisted her ankle very badly. It was swollen to twice or three times normal size. The doctor (a different one from above) poked at it, didn't probe it too deeply and told her, "Rest and paracetamol" (acetominophen). That's it. No icing. No compression. No elevation.

Neither one of the offices ever got our basic medical histories from either of us. We never answered any of the questions you normally fill out for a doctor's office.

I did, however, receive a survey from the NHS asking about OB services. You'd think they would at least limit the surveys to those who have ever used their obstetrics services and not send it out to random females in their system regardless of whether they had ever used any OB services.

CWJ said...

@clorinda

Oh lord. What can one say.

sydney said...

From Tibore:

The question is, how do practitioners deal with symptoms such as this case leading the diagnoses astray? Yes, that's probably 4-plus years of classes and experience to fully answer, but I'm looking for what the general philosophies are about dealing with misleading symptoms and differential diagnoses leading you away from what the problem ultimately is. How do practitioners manage to keep in mind possibilities when data leads them off those alternate possibilities trails? And getting specific: What would be the threshold in a case like this for a doctor to say "You know, the symptoms don't match, but let's test for TB anyway"? Or is there even such a threshold?

It's a little hard to answer that question with this case, because the symptoms as described in the newspaper article do sound like TB, and she had a prior history of TB, as well as recent travel to country with endemic TB. It should have been on the top of the differential list, especially if she didn't get better as soon as one would expect for a typical cold or other lower respiratory infection.

To answer your question more broadly, though, we follow algorithms. We know that a given illness generally presents in a given way and has a given natural history. We treat based on the best guess for the circumstances and wait to see what happens. If everything gets better, we were right. If not, then it's time to take the next step in the algorithm. What's the next most likely diagnosis based on the symptoms? Did any new symptoms or signs develop since the original therapy? Do we need to do more tests to get more answers?

Consider a cough. Initial visit with doctor, present for three weeks, not getting better. No fever. No other symptoms. Treat for bronchitis. Two weeks later, no better. Get chest xray, re-examine and requestion patient, look for possibilities that his medications could be causing it, that it could be caused by reflux, or some other infection. Maybe try something for acid reflux. Four weeks later still not better. Abandon reflux theory. Check for TB, consider bronchoscopy, etc. etc.

It's a process. And it requires that the patient be willing to come back for follow-up and accept the process as we wait for the diagnosis to manifest. Sometimes people become impatient and go elsewhere seeking answers when the first step fails. This usually means that they end up starting at the beginning again with each new doctor, and they may never get to the bottom of the case as a result. I wonder if something like that happened with this patient.

sydney said...

Maybe I didn't answer Tibore's question. "How do practitioners manage to keep in mind possibilities when data leads them off those alternate possibilities trails?"

It is difficult. An unusual presentation can easily mislead you. In America we tend to test for every possibility when someone isn't responding as anticipated. That's one reason we spend so much on healthcare compared to other countries.

"And getting specific: What would be the threshold in a case like this for a doctor to say "You know, the symptoms don't match, but let's test for TB anyway"? Or is there even such a threshold?

In America today, the threshold is lower than in countries with nationalized healthcare. Most US doctors would probably have tested her after the second or third visit for TB. Certainly once she landed in the hospital it would have likely been looked for.

That may change in the future when we become stingier with our resources. They pride themselves in the UK on only running "necessary" tests. They rely more on their diagnostic skills than on lab tests. We rely more on lab tests than diagnostic skills - especially in recalcitrant cases. We spend more money, but we probably miss fewer of the unusual cases.

Tibore said...

Oh, thank you for the responses sydney. I appreciate that. Yes, those are excellent answers. I had wondered.