A 35-year old woman had pain in her leg and was operated on in the Thimphu Hospital.
A few days later, her back swelled up so she had to undergo a second surgery. Her body started to dysfunction after that and she had a problem going to the bathroom. This kept her bed-ridden for three months.
One of her relatives said traditional medicine and hot spring soaks eased the pain to some extent.
Now, though she is relatively fine, she has to visit the toilet at specific times.
Similarly, another patient suffering from high blood pressure (diabetic patient) consulted a doctor who prescribed a medicine which made her body swell. Her legs became double the normal size.
Panicked, she consulted the same doctor again who was shocked and prescribed a new medicine. But even those did not work and her family had to take her to Siliguri, India since she could not even walk.
The Indian doctor scolded them for their carelessness and said they were lucky adding that had they been late by a few more days she would have been paralyzed or not even survived.
In another case, a patient who had been diagnosed with stomach ulcer had been taking medication and avoiding certain food for a long time. But the pain persisted so she went for a second check-up but this time after the ultrasound a gallstone was detected.
Her daughter said her mother was sick since she was little and only recently after the correct diagnosis and medication is she well. “I still can’t forget the nights of suffering she went through.”
However, a psychiatrist at Thimphu hospital, Dr Damber Kumar Nirola said wrong diagnosis is not uncommon to any particular country or hospital.
He pointed out that there are several reasons behind wrong diagnosis like a patient misleading a doctor by citing wrong symptoms. For instance, many patients who have psychiatric illnesses believe they have physical symptoms and never talk about their emotions which may lead to missed diagnosis.
Hiding certain information such as saying that a person does not drink alcohol and over flooding of hospitals with patients are a few factors that may cause a doctor to examine a patient in an incomplete manner.
Asked if it is the doctor’s fault, too he said it was, partially.
But when there is a never ending queue of patients, and shortage of doctors it leads to fatigue for the examiner, he added.
“A thorough examination takes as much as half an hour and sometimes we have to see more than 50 to 60 patients.”
Or sometimes, the doctor’s range of knowledge may be limited or in updated.
The Director of Department of Medical Service under Health Ministry, Dr. Ugen Dophu said that 95% of the diagnosis is a result of verbal questioning and cursory examination of the patient and only 5% through lab and other diagnostic tests.
To prevent wrong diagnosis, the only option available right now is to limit the number of patients a doctor sees in a day, said Dr Damber K Nirola.
The Special Consultancy Service in Jigme Dorji Wangchuk National Referral Hospital from 4 to 7pm keeps the number of patients at a maximum of 12 and they are mandated to at least 15 minutes of examination.
To keep a doctor updated with the latest skills, it is mandatory for him or her to do Continuing Medical Education (CME).
According to Dr Ugen Dophu problems of this nature will be addressed once a medical college is established in Bhutan.
“We are going to have a separate subject on how to behave, communicate with the patient and try to understand him,” he said adding that such things were not taught in medical colleges in big universities.
If medical equipment or the reagents used in tests do not meet certain standards, it can also lead to wrong diagnoses.
“A good history, a good clinical examination, and a good investigation” were cited by Dr Damber K Nirola as prerequisites for correct diagnosis.
“Most importantly history of medicines taken is very important.”
As far as possible stick to the same doctor as he or she will know the patient’s medical history, he added.