It turned out to be a few dozen: A misdiagnosis

Dr. H was working in the emergency room of a hospital on a Navajo reservation. Dozens of people had recently come to the hospital suffering from viral pneumonia. Blanche Begaye (a pseudonym), a Navajo woman in her sixties, came to the emergency room because she was having trouble breathing. She is a compact woman with long gray hair, worn in a bun. She told the doctor that she had begun to feel unwell a few days earlier. Thinking she had a bad cold, she had drunk orange juice and tea, and taken a few aspirin. Now her symptoms had worsened. She now had a slight fever, and was breathing at almost twice the normal rate. Her lungs sounded clear. A chest X-ray and a lab test of her white blood cell count made the flu or pneumonia unlikely.

However, her blood had become slightly acidic, which can occur in the case of a major infection. The doctor told Blanche that he thought she had “subclinical pneumonia”—an early stage of the infection, as the virus had not yet affected her lungs in a way that would show up on the chest X-ray. He ordered her to be admitted to the hospital.

A few minutes later, another doctor discovered that Blanche actually had aspirin poisoning. She was an absolutely classic case—the rapid breathing, the shift in her blood electrolytes.

Dr. H. had misdiagnosed her because the widespread viral pneumonia he had been seeing was uppermost in his mind. Rather than try to integrate all the information he had about her illness, he had focused on the symptoms that she shared with other patients he had seen: her fever, her rapid breathing, and the acidity of her blood. He dismissed the data that contradicted his diagnosis.

When he had asked whether she had taken any medication, including over-the-counter drugs, she had replied, “A few aspirin.” Dr. H. explained, “I didn’t define with her what ‘a few’ meant.” It turned out to be several dozen.

Advice for patients and advocates: Prepare a summary of your symptoms for the doctor, and be specific. If Blanche had specified the number of aspirin she had taken, she would have made it much easier for the doctor to diagnose. The doctor is on your team; treat him that way, and help him do right by you.

Read another story of a preventable adverse reaction, or read Dr. Groopman’s article in the New Yorker.