Sign her up...

[dr.weiner]

Advertisement - Members don't see this ad

The Lebron James of Pathology:


"Teen diagnoses her own disease in science class"
http://www.cnn.com/2009/HEALTH/06/11/teen.self.diagnosis/index.html

In her Advanced Placement high school science class, she was looking under the microscope at slides of her own intestinal tissue -- slides her pathologist had said were completely normal -- and spotted an area of inflamed tissue called a granuloma, a clear indication that she had Crohn's disease.

 

[yaah]

There are lots of things wrong with that article. Perhaps the worst is the statement that a single granuloma is a "clear indication that she had Crohn's disease." It is not. Granulomas do not make it crohn's disease and you don't need granulomas to make the dx. And if she really has Crohn's disease (despite, apparently, negative biopsies apart from one tiny abnormality) wouldn't the clinicians have been all over it? We see biopsies on people all the time who have "Crohn's disease" yet have never had biopsy documentation of anything, or who have negative biopsies. That doesn't prevent the diagnosis from being made by other methods. I hate the media.

 

[Dermbound00]

There are so many things wrong with this story, not the least which Yaah pointed out.

This article goes to show how little people really know about Pathology. You want to get even more irate? Read some of the comments at the bottom of the article by the general public. The pathologist should be sued or even lose their license for not diagnosing Crohn's based on one apparently small granuloma?

First off, anyone that has sat behind a microscopic and issued a diagnosis for any appreciable amount of time has made an error. Everyone! We all have error rates in pathology. Granted the big name out at an East Coast School may have an error rate of 1 in 300 while Joe Schmoe out in a private practice in Nebraska may be at 1 in 70 but it is a fact of life.

I have been fortunate to be at an institution that gets a number of cases for second opinion initially diagnosed at an outside hospital, including major academic institutions, where the pathologist that issued the initial diagnosis was a big name in the field (i.e. numerous powerhouse publications and books) and had a major error (one that impacts patient prognosis and/or therapy). We all strive to always be right but the fact is a pathology biopsy has a sensitivity and specificity attached to it that is multifactorial. It is the clinicians responsibility to integrate all of the lab findings and clinical picture and know this fact. A negative biopsy does not necessarily mean the person does not have a disease. It means based on the biopsy given there is not enough evidence to warrant a specific diagnosis. If a patient's symptoms persist and are this bad, maybe the clinician should consider another option including rebiopsy.

The problem with error in pathology is that there is no gold standard to base it on. Right now the way we tell error from accuracy is by precision. Out of 10 big wig pathologists which diagnosis is the most common. Is that really scientific? Probably not, but it is the best we have.

 

[gavilan]

Agree with all the above.
Also, I am willing to bet she has a dad/relative pathologist, who reviewed the slides, saw the granuloma, and said "aha!" and proceeded to set things up to make a splash in the media, with her daughter as the star. A high schooler making a diagnosis of Crohns.

 

[PresterJohn]

This also means that every hypochondriac with a negative biopsy is going to request their slides. Fisher-Price microscope sales are sure to skyrocket.

 

[Dermbound00]

Yeah no kidding.

What really is bad about the whole thing is who should pay for the second opinion? Insurance companies feel that they shouldn't pay for a redundant exercise when a board certified pathologist has already looked at it. I definitely do not think pathologists should be looking at these slides for free or minimal payment.

The other thing that this story portrays is that pathology is easy. Anyone can do it, even some high school girl. Well you know what? Most physicians are clueless about what pathologists do. The most some of these other doctors know is "blue is bad". They always try and come in the frozen section room and act like they know what they are looking at, but most of them are clueless. Pathology knowledge is not something that you are born with. Our field is very difficult and demanding (as most of us who have taken boards know) if you want to be good at it. You have to push a lot of glass and do a lot of reading if you want to be a good pathologist. Even then you are not immune. You are not born with what a myxoid liposarcoma looks like and the translocation imprinted in your head. It takes work. You just dont stroll into an office throw a slide down and make a diagnosis. I have seen several dermatology trained dermatopathologists think this stuff is easy and start diagnosing deeper soft tissue lesions and lymphomas only to get burned.
This is not a joke of a field where anyone can stroll in with a few weeks of training and start making diagnoses, much less anyone with at least one eye and a fisher price microscope.

 

[HbyHA]

This article goes to show how little people really know about Pathology. You want to get even more irate? Read some of the comments at the bottom of the article by the general public. The pathologist should be sued or even lose their license for not diagnosing Crohn's based on one apparently small granuloma?

the comments below are hysterical, yet sad at the same time. remember, a little (misinformed!) knowledge is a dangerous thing!

 

[Kitra101]

the comments below are hysterical, yet sad at the same time. remember, a little (misinformed!) knowledge is a dangerous thing!

I hate to tell you all this, but there is a general feeling among the lay public that they know how medicine should be done better than those trained and practicing in it. Ms. Cohen, the writer who spews out this garbage on CNN and exacerbates this idea of dont trust your stupid evil doctor has a page of her own full of articles to insight rage...check some of these out:

http://www.cnn.com/SPECIALS/2007/news/empoweredpatient/

I would like to do an empowered blog about how the media preys off the publics fear and makes problems much worse. The media constantly insights panic to boost ratings. For example, this whole economic turndown was not helped out at all by the media. I would argue that they made this even worse than it would have been.

 

[yaah]

the comments below are hysterical, yet sad at the same time. remember, a little (misinformed!) knowledge is a dangerous thing!

Those comments made my blood boil.

CNN in particular has a nasty habit of not getting proper reporting and expert opinion on medical stories. And they also have a nasty habit of presenting "both sides" of a controversy when all of the evidence is actually on only one side. Like the vaccine-autism "controversy."

 

[Cloaca]

I love the comment from the person who suffered from abdominal pain for a year and kept going to the ER but never got an answer. How about seeing an internist???