Without questioning this intelligent woman: Angina misdiagnosis

From Dr. Bernard Lown on "Getting Doctors to Listen:"

One experience illustrates the mayhem wrought by self-diagnosis. Mrs. T., a woman in her mid-eighties, had been completely crippled by postural hypotension for the past five years. Each time she stood, dizziness and light-headedness caused a near faint. She became bedridden, burdening family and growing depressed as a result. She was on a bevy of drugs for angina that indubitably contributed to the drop in blood pressure when she stood.

On careful discussion, it was evident that this woman did not have angina; her chest pain was caused by arthritic and musculoskeletal problems.

I tried to determine how the diagnosis of angina had been arrived at, and the patient admitted to having suggested it to the doctor. Comparing notes with a friend who had experienced a recent coronary heart attack and suffered thereafter from angina pectoris, Mrs. T. grew convinced that her problem was identical. After further discussion with her sick friend, she absorbed some of the appropriate descriptive terms. On the initial visit she told the cardiologist that she was certain her condition was due to angina. The doctor, without questioning this intelligent woman, prescribed the usual anti-anginal fare. Since none of the medicines helped, more drugs were added on many subsequent visits. When she became totally disabled, Mrs. T. sought a second opinion from me. When all medicines were discontinued, the vertigo and the other symptoms disappeared, except for the chest pain, which she now took in stride.

There is no excuse for a doctor's not going beyond a patient's labeling of a problem. Nonetheless, caveat aeger, "let the patient beware.”"Avoiding the role of accomplice in self-victimization is a modest first step.

Advice: Be informed, but let the doctor make the diagnosis.

Read another happily ending misdiagnosis story here, or read more from Dr. Lown's book, The Lost Art of Healing: Practicing compassion in medicine.