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Anatomy Of A Misdiagnosis

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Hopefully, a doctor out there will learn something from this.

Here, as part of the Institute for Healthcare Improvement’s Open School, Academic Advisor James Moses recounts the distressing story of a Lauren Mason, an 18-year-old college freshman with terrible pain on the left side of her face who was misdiagnosed by a reputable ENT specialist at a major Boston teaching hospital.

Dr. Moses interrupts his storytelling periodically with leading questions about Lauren’s care (for instance: “Has the case been centered on the patient thus far? Why or why not?” or “If you were Lauren’s ear, nose, and throat specialist, what else would you have said to Lauren’s mother? Would you apologize for the misdiagnosis?”) Here’s a snippet of Lauren’s saga:

During four hours in the office, she endures a long series of tests, including more for her balance and equilibrium. She also spends time in the Audiology Department and gets extensive hearing tests done.

Finally, the doctor diagnoses Lauren with a case of internal shingles in her ear canal. He explains that since she had chicken pox when she was little, she is susceptible to getting shingles. Lauren asks if he can see anything like shingles inside her ear. The doctor says no, but surmises that there was an outburst a few months ago and that the nerve damage was becoming evident now. He explains that it’s a disorder called postherpetic neuralgia and that she may also have trigeminal neuralgia, or unexplained pain that affects parts of the face. The doctor prescribes an anti-seizure medication (to help calm the nerves causing pain), an opiate to help manage the pain, and a stronger painkiller for especially difficult episodes. Lauren is instructed to take the pills three times per day.

The visit ends with the doctor telling Lauren that here is no guarantee the pain will ever go away…

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