A Reason for Medical Modesty

● There are members of the medical profession who are prone to express themselves quite dogmatically. So often, they are absolutely sure that their judgment is right and should not be questioned by the ‘layman.’ But what are the facts?

Highlighting the mistakes doctors make in diagnosing patients is the article appearing in the New York State Journal of Medicine, August 1, 1967. It is entitled “Lack of Correlation Between Antemortem and Postmortem Diagnoses.” That is, it shows where autopsies contradicted the diagnosis made by the physician while the patient was still alive. After stating, “Literature abounds with examples of antemortem versus postmortem discrepancies,” the article gives some statistics regarding eleven kinds of diseased conditions.

Among other things it reports that in pulmonary embolism, such as a blood clot in the circulatory system of the lungs, less than 50 percent had been diagnosed correctly; the errors ranging from 10 to 89 percent, depending upon the series. Diagnoses of gastrointestinal hemorrhage, that is, bleeding from the stomach or the intestines, were found to be mistaken 33 percent of the time. The majority of cases of renal infarction (areas of dead tissue in the kidneys) were not recognized prior to death; the same was true in the great majority of cases of myocarditis, that is, inflammation of the muscular wall of the heart.

In France, autopsies of 1,000 cases showed that only 55.4 percent had been accurately diagnosed beforehand. And in 23.5 percent there were serious secondary disease conditions discovered only after death.

A case in point: A woman who had a habit of gagging while eating died from choking while eating in a restaurant. Two doctors diagnosed it as a serious form of heart attack. An autopsy, however, showed that she had choked on a piece of steak. A correct diagnosis might have saved her life.

This medical article further comments: “That autopsies often correct diagnoses . . . is an objective commentary on how much medicine still has to learn.”

Since this is so, is not modesty a virtue that members of the medical profession should cultivate?