Drive across country without a map: Misdiagnosis & medical decision-making

The patient was a boy who was very ill with a severe childhood disease called hemorrhagic shock and encephalopathy syndrome. His doctor, Stephen Borowitz, says the boy had significant neurological damage and was fed through an intravenous feeding tube.

The immediate problem was that he had a fever. But he was showing other symptoms that didn't match his condition. "He had developed diarrhea, which is extremely unusual for him, and he seemed uncomfortable," his doctor said.

So the doctors consulted Isabel, a Web-based medical technology that generates a list of possible diagnoses based on the patient’s symptoms. The computer program suggested the doctor consider gallbladder disease, which he had not thought of.

An ultrasound was ordered, and gallbladder disease was indeed the problem, and it may not have been related to the boy's pre-existing condition or his feeding tube.

"The mind can't possibly deal with the complexity of the problem that a patient presents," Prof. Larry Weed says. "What if you said, 'Let's give (doctors) eight years of geography at Harvard and then let them drive across the country without a map'?" Dr. Weed, best known as the developer of the problem oriented medical record many years ago, has developed a similar medical diagnostic tool, the Problem-Knowledge Coupler. Such electronic tools can powerfully assist doctors in diagnosis.

Advice for patients with conditions that are difficult to diagnose: Find such a program, or a doctor who uses one, or use the online Mayo Clinic resource via the link in the Resources and Links section, below on the right side of this blog page.

Read another of our Isabel stories, or read Erin Donaghue's source story in USA Today of Sept. 6.

Thanks, Andrew Law.