Wrong diagnosis. Many times have I heard friends expressing their sheer outrage over the assumed incompetence of a doctor who misdiagnosed them as having an ailment which later turned out to be something else. And many of these times if you listen to their story, you could pick up facts that shows that though the doctor's diagnosis turned out to be wrong, he was neither incompetent nor professionally lousy. The fact is that the science of medicine, like most human endeavours, is not perfect, the very fabric of its underlying principles to some extent is flawed, such that even if you follow the rules to the least sometimes you just come out wrong. The art of diagnosis involves the use of symptoms, signs and relevant laboratory investigations to arrive at a probable cause for a patient's distress; a form of Inductive reasoning though sometimes it plays out in the form deductive reasoning, and at other times a combination of the two. This, like the situation with the noble gases of the periodic table, would have been perfect in an ideal situation where particular symptoms are peculiar to specific diseases. But in the complex world of reality where ideal situations are not obtainable, and many diseases share similar symptoms, it becomes a game of probability. More like trying to identify similar objects from their shadows, Suffice it to say that diseases are like objects casting symptoms as shadows.
image from blogs.lawyers
How difficult that can be!
Recognising this shortcoming of a supposedly perfect science, doctors usually talk about diagnoses in terms of probability rather than absolutes. Except of course in glaring cases. Thus expressions like most likely has X", "a probably case of Y", has a tumor, which is probably cancerous are used to covey the uncertainty. Also terms reflecting the degree of certainty of a diagnosis are used. Examples include:
DIFFERENTIAL DIAGNOSIS
a shortlist of clinical conditions with symptoms similar to that being manifested by the patient, each of which therefore has the probability of being the patient's primary pathology.
TENTATIVE DIAGNOSIS
which is the most likely out of the shortlist of differentials, which therefore serves as the working diagnosis. Lastly
DEFINITIVE DIAGNOSIS
which is the diagnosis when confirmed to be accurate beyond reasonable doubt.
Sometimes clinical investigation, that laboratory tests, helps to improve the probability of accuracy of a diagnosis, drastically reducing the incidence of misdiagnosis. But even that has its own flaws, similar to the limitations of clinical evaluation.
For example a radiologic finding on Chest X-ray of Aortic Unfolding does not confirm a diagnosis of Hypertensive Heart Disease, as an Aortic Arch Aneurysm,Atherosclerosis, or even Old age can give the same x-ray finding. Similarly, elevation of biochemical markers like creatinine,urea,CRP, liver enzymes, etc; each has scores of possible explanations/causes.
However just like some clinical findings are pathognomonic peculiar to, and some clinical scenarios are highly suggestive, of specific diseases; some investigations are outright diagnostic.
image from gstatic
COMPARISON DRAWN FROM THE LEGAL SYSTEM
When the competence of a judge that presided over a case is being assessed, it is [ or at least should be] done by weighing the validity of his rulings on the scale of the evidence, on a background of the tenets/principles of the legal system. In the reality of things, he may end up convicting/acquiting the wrong person. But that doesn't make him incompetent or corrupt as long as the direction of his ruling points towards the True North in the magnetic field of the evidence. Fact is a judge is not a clairvoyant, neither is he an omnipresent time-traveler, that he could psychokinetically simulate the crime to know the facts in their actual sense. So he makes judgement based on what is presented to him. Now replace Judge with Doctor, evidence with symptoms, and witness or foresnsics with lab investigations, and you would get proper perspective.
CONCLUSION
Sometimes an incorrect diagnosis does not necessarily translate to medical cum diagnostic incompetence on the part of the physician , but could rather be a reflection of the fallibility of an Imperfect science.
When questions about medical /diagnostic competence arises, what should matter is the rationality of the diagnosis in the light of the symptoms and signs, and indeed the overall clinical scenario, including taking into cognisance variables such as age, sex and race of the patient.
REFERENCES
Wrong diagnosis of a medical conditionOriginal content created by me https://steemit.com/steemstem/@chidiebere/wrong-diagnosis-the-shortcomings-of-an-imperfect-science
69.495 SRY