The Effects of False Positives and False Diagnoses

There’s no shortage of stories about the dire effects of a missed diagnosis. But what about the repercussions of a false diagnosis?

Two doctors writing on MedPage Today say that the medical industrial complex should be equally concerned about the number of patients diagnosed with a specific disease who do not, in fact, suffer from it. “How prevalent are false diagnoses of disease?” they ask. “And which ones?”

Clifton Meador, M.D., and George Lundberg, M.D., previously have raised the flag of inquiry into how anyone can accurately assess a diagnostic process in light of increasing numbers of people described as “well and worried well” who seek medical treatment. A troubling aspect of “this influx of well people,” they say, is an increasing number of test results that show false positives–the indication of a problem when there isn’t one–and its corollary, false diagnosis of nonexistent disease.

If you don’t have an accurate picture of the incidence, demographics and nature of a disease or disorder, you can’t organize the most effective response to it. Or the most cost-effective–you’d have to live on Jupiter to be unaware of the escalating cost of medical care.

As the MedPage authors point out, medical literature “is filled with studies on the accuracy of specific disease diagnoses but the focus has been exclusively on missed diagnoses.” A common metric of analysis here is data from autopsies to determine how many patients died while suffering from a specific disease that was overlooked while they were alive.

Why, they want to know, don’t we seem to care about the flip side of that review? That is, how many people were falsely diagnosed with a specific disease while alive that wasn’t in evidence upon their death?

They found only one paper that examines the prevalence of false diagnoses of a specific disease within a defined population. It concluded that four times as much disability came from the false label “heart disease” as from actual heart disease.

This isn’t about the occasional hypochondriac who seeks medical attention because other forms of attention are lacking in that person’s life. False positives and overdiagnosis have consequences. For a person who has been diagnosed with a nonexistent disease:

  • The patient starts on the conveyor belt of further testing and treatment, which can bring their own side effects and complications.
  • The disease cannot progress because it does not exist.
  • The patient is often satisfied to have a name, any name, for his or her problem, even if the disease does not exist.
  • The doctor is satisfied to have named the condition, believing the diagnosis to be correct.
  • The false positive test result leading to the diagnosis may become negative when repeated in the future, reassuring the patient and the doctor that the “disease” is in remission or is a mild form. But unless the patient sees another doctor who doubts the false diagnosis and repeats the testing, the false diagnosis will persist.

“Our 50 years in medicine tells us that this error is common,” say Meador and Lundberg,”and that it is very difficult to remove a false diagnosis of any disease.

If the question about why scientists and their enablers ignore errors of false diagnosis remains unanswered, at least you, the patient, can help disrupt the cycle of false diagnosis/overtreatment/financial waste by:

  • considering the possibility that you might not be unwell, only worried about being unwell;
  • keeping complete records of symptoms of illness–what they are, when they occur, patterns about when and under what circumstances they appear and subside;
  • asking your doctor what else can cause your discomfort besides the problem she has diagnosed;
  • seeking a second opinion; and
  • consulting a psychological therapist to examine if physical symptoms can be the result of emotional disturbance.
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