A new report from the Johns Hopkins Armstrong Institute Center for Diagnostic Excellence details a sobering estimate: 795,000 American patients will be disabled or die each year from misdiagnosis. As a newly minted Radiation Oncologist, I boldly asked to address the medical staff at it’s monthly meeting in my first position out of residency, 1992. I was a pipsqueak as far as experience was concerned, but I hoped I could at least offer some help to my fellow physicians while expressing the need for team effort.

After my presentation which was filled with overhead slides (remember them?) you could hear a pin drop. Everyone seemed to hold their breath. The chief of Oncology was shocked at my naive boldness. Also, as one of the only female physicians on staff, it was even more daring. Today it seems I was on target and would do it again.

I reviewed slide after slide of patients’ scans who were misdiagnosed or late in diagnosis- not to chastise them, since many examples were not from their hospital, but to raise awareness. There is a list of diseases easily missed, some of which are cancer (heart attacks are missed only 1.5%). Hoping to avoid raising a problem without a solution, I offered a simple idea which was employed in my 16 years of practice there.

ALWAYS THINK CANCER! Always include cancer as a possible differential in the diagnosis. If it is not clear, send them to us and we can figure it out for you. We know what scans and tests to run. No need to package the cases with a bow after all the workup and biopsies are done. We can help you.

Today with liquid biopsies, pet scans, etc. we have many more tools and know which to employ. “Ok, Joanne well now you scared me; what am I supposed to do?” Simple. When you or someone you love has an issue, ask the doc, “Could this be cancer? Can we do a test to rule it out?” Over the years I have had patients ask for a consult with me for just that reason. You have the right to be seen. It’s why you pay for great insurance, so take control and use it. Pulmonologists, Neurologists, oncologists, hematologists, gastroenterologists… all the “ologists” do this everyday and can quickly triage the situation.

With the increased use of “artificial intelligence” in medicine, we will find these almost 1 million misdiagnosed events sooner and when they are more treatable, but you don’t have to wait.

Carly is at her mother Mae’s bedside this week. She is a nurse who flew down from north to get involved. Mom has been in and out of the hospital and her elderly husband is beside himself. Finally it is decided that she actually has cancer not infections. Everyone wants to know why it took this long.

Rest assured that intelligence is moving in your favor and we will more quickly make the right diagnosis earlier with new technology. But the human factor remains and I hope to remind you that you are the one empowered to help yourself. Just as I advised that hospital staff of over 100 physicians, I encourage you: think cancer. If it truly is arthritis not spinal metastasis, on the workup, or a biopsy is negative, then at least it was not missed.

Hospitals and insurers are working fiercely to cut costs. Patients are discharged quickly. Scans and tests are denied and oncologists have to fight for them. BUT we all must accept nothing less than good effort. We must not be dismissed. This is your life. Be bold in your demands. Get second opinions. Get the best insurance you can afford (my soap box again) so prior authorization does not gum up the work up.

Tiny elderly Mae in the hospital bed was actually happy to finally receive a diagnosis and plan of care. She and her husband had not tears of fear but joy. “Doc I thought I was losing my mind. I am so relieved that we know what is wrong”.

Do not be intimidated by searching for cancer. An early diagnosis is all the difference in your well being and outcome. There is nothing artificial about better diagnosis and intelligence. Your life is worth every effort.