If, if, if: A lab error story

Claire Packer, a 49-year old Englishwoman, had had anorexia for almost half her life. The eating disorder, related to an obsessive fear of gaining weight, may have weakened her bones (osteoporosis). When she fell down the steps in her garden in summer 2005, she fractured her thigh bone (femur). An earlier operation to put metalwork in her leg had failed, so surgery was needed again on July 14. After her surgery, Ms. Packer became ill with diarrhea. But a stool sample taken on July 21 was not tested until five days later, despite requests for test results made by medical staff on July 22. Although it would have been best practice for someone in Ms. Packer's medical condition to have been attended by a member of the physician's team daily, this did not happen from July 23 to 27.

An opportunity was lost to begin treatment for what turned out to be a serious infection with the superbug Clostridium difficile.

She died on July 31, 2005. The causes of death were specified as E-Coli endotoxin (septic) shock, Clostridial toxin antibiotic-related digestive disease (colitis), and malnutrition as a result of her anorexia.

Now, almost two years later, the deputy coroner has returned his verdict, on April 11: neglect contributed to her death. Her mother commented, "If the doctors had made the effort to go and see her, if they had recognized her symptoms, if they had requested and chased her test results, she would probably be alive today."

Advice to hospitalized patients and advocates: Ensure lab results arrive and are interpreted and heeded promptly.

Read another of our lab error stories, or Miriam Craig’s source story.

We demanded another X-ray: A medical misdiagnosis error

Before her fall last May 24, the mother of five was an active woman, who visited the supermarket once a week and regularly walked round Leyland Market in the United Kingdom with her husband.

The fall left her bedridden and in severe pain, and the pain led her to a hospital’s Emergency Room. There, staff gave her an X-ray and then told 84-year old Sarah Jackson there had been no fracture to her leg.

But her daughter in law was firm: "We demanded another X-ray," three weeks later. Doctors then found a break, and transferred her to a hospital that could perform a hip replacement. The operation took place on June 19. She died on July 8 after the wound became infected and she developed a blood infection (septicemia).

Now a court is holding an inquest about why her broken hip was undiagnosed for three weeks.

Advice for patients and advocates: Remember that the interpretation of X-rays is very subjective. Insist on an independent reading if you suspect the radiologist X-ray reader missed seeing a fracture.

Read another hip fracture misdiagnosis story, or read the source story.

If hip ain’t broke, don’t fix it: A near miss diagnosis

Sofia (not her real name) is an active 83-year old girlfriend and grandmother of four, an ex-skiier from the days when young women didn’t ski. Back then, she had broken her leg on the ski slopes. Now, with no reason last Friday, she suddenly had developed excruciating pain while walking.

She called her doctor, who had her come in to see a colleague who was covering for him while he was out. The covering doctor admitted her immediately to the local community hospital in suburban Connecticut. There, based on her X-rays, a surgeon prepared to operate the next day on her hip fracture. The surgeon planned to install three screws in her right hip to stabilize it.

Sofia’s family prepared for a difficult operation and a lengthy and painful recuperation. Then, suddenly, the next day, they received a phone call: there was no hip fracture. Two of the three X-rays had found nothing, and the third had found a line suggesting a possible fracture. The surgeon had ordered an MRI, which clearly found no fracture. Sofia scooted out of there as fast as she could.

X-ray interpretation is very subjective. Radiologists will disagree on about a fifth of all Xray films, or more, according to Dr. Jerome Groopman on Wednesday on National Public Radio.

Advice: If an X-ray film is ambiguous, ask for a second opinion, or for some other kind of test, to corroborate it. And, Sofia adds, Don’t get sick on a weekend.

Read another misdiagnosis story.