In his study, Dr. Schiff found this kind of misstep, called a history taking error, about 10 percent of the time.
These kinds of questions are important because they can open up diagnostic possibilities that the doctor may not have considered. A thorough family history, for example, can reveal genetic predispositions to disease. Other questions, like where you’ve lived or the kind of work you do, may be critically important to your diagnosis.
For example, in May 2009, the Food and Drug Administration warned doctors that histoplasmosis and other invasive fungal infections were not consistently being recognized in patients taking TNF-alpha blocking drugs.
Histoplasmosis is caused by an organism that can lie dormant in the body harmlessly for years, but the infection may flare up if the immune system is weakened by medication or illness. The fungus that causes histoplasmosis lives in the soil, typically in areas around the Ohio River Valley. If you have lived in that area, or worked in the soil, and you take a TNF-alpha blocker, your doctor needs to know.
Likewise, people with particular jobs face a higher-than-average risk of repetitive strain syndromes, such as carpal tunnel or low back pain. A habit of gum chewing can increase the risk of problems in the temporomandibular joint, the hinge of the jaw.
Putting the Puzzle Together
For many people, the problem of misdiagnosis is resolved relatively quickly, with no lasting impact.
But Muller says years passed and her pain never went away, despite multiple explanations proffered by doctors.
Finally, the moment came when her hips would no longer move. She bent over to pull on her pantyhose and couldn’t get back up.
When her new orthopaedic surgeon looked at the X-ray of her pelvis, he found that the round head of her hip joint was sunken and squashed, like an orange that had rotted and collapsed.
Despite the grim news that RA had ravaged her joint, Muller felt relieved. “I actually cried tears of happiness because I could point to the darn X-rays and say, I am not making this up. You could see there was something wrong,” she remembers.
And now, when she hears about other patients who are suffering without answers, she has this advice.
“Medicine is an art and not a science and unfortunately most doctors rely way too much on the tests. Try to find a doctor that just sits and listens to you,” she says. “When a doctor stops listening to you, you need to go to another doctor.”
