October 23, 2011

Prompt and accurate lab tests panacea to misdiagnosis

Prompt and accurate lab tests panacea to misdiagnosis

The growing problem of misdiagnosis occasioned by poor state of laboratories in Nigeria and inability of health professionals to carry out accurate diagnosis before treatment has  become a public health concern.  This has not only caused a lot of medical errors but had led to the deaths of so many Nigerians.

Yinka Ademola, became a victim of wrong diagnosis when she was wrongly treated for malaria and typhoid causing her untimely death.  When she first noticed the signs of the ailment, she sought medical attention  in a private hospital. After one year of medical treatment, her condition was not better, her family became worried.

They moved her to another hospital where immediate laboratory tests were properly carried out on her. Contrary to the earlier diagnosis, Yinka was diagnosed of  having a heart- related disease which had already damaged her organs. She died 24 hours after she was admitted. Clinical indications showed that the long use of malaria and typhoid adversely affected her heart.

Yinka and many others who have died due to delay in obtaining the right laboratory test may have survived if they were properly diagnosed and treatment commenced immediately.

Worse still, misdiagnosis of life threatening illnesses such as cancers, diabetes etc., has become commonplace. Although in most cases, the medical error is not immediately detected and even when detected, the patient’s condition may be irreversible. This is  because the wrong treatment has wrecked havoc like in the case of Yinka.

Mary Egwu, 35, like any other health conscious woman was carrying out her monthly breast self examination when she found a tiny lump by her armpit. It was not hurting but it was just there.

Mary immediately made an appointment with her company’s physician. After brief examination,  the doctor asked her to see a surgeon who removed it two days after. Mary was told that the lump would be taken to the laboratory for further tests.

Few weeks later, she checked and was told that the results were ready. So she waited anxiously to hear from the surgeon. Without mincing words, the doctor announced that she had a very rare cancer.  Still mustering courage to assimilate the news, she was told that the laboratory result was delayed because a second opinion was needed. Unfortunately, the two laboratories confirmed the results. Mary was heartbroken but also not convinced that she has such illness.

However, her family members were determined to save her life. They rallied round and booked an appointment with an oncologist. On looking into her medical record, the oncologist requested  another opinion which came out negative to any form of abnormalities.

A few days later, a new doctor took over her case and examined her and recommended her biopsy be sent to a specialist who confirmed she hd no cancer. But for these timely laboratory tests, Mary would have ended up like many Nigerians who have been treated of diseases they never had due to wrong diagnosis.

In Nigeria today, the incidence of wrong diagnosis has been seen  in almost all health conditions.

It is now commonplace to find doctors telling people when they are sick that they have malaria whether or not they test for it. Thanks to the recent directives by WHO that all patients suspected to have malaria must be tested before treatment.

Misdiagnosis is known as wrong, inaccurate or incomplete diagnosis and consequently treatment of a disease, injury, syndrome, behaviour, infection or other ailment. Some disease conditions can be over-diagnosed, under-diagnosed or overlooked, while some may be difficult to diagnose early.

Many people both infants and adults across the world are dying needlessly because they are not being tested early enough before administering any type of treatment. Many of them would have been alive today if proper laboratory tests were initiated almost immediately.

Despite the proliferation of laboratories in all nooks and crannies of the country, the test results are usually questionable. Many of the laboratories have obsolete equipment, untrained staff and above all, there are no strict regulation in place. The worst is that the government does not see laboratories as priority.

In the view of Dr.Pamela Ajayi, Managing Director PathCare, Nigeria said  prompt diagnosis with required laboratory investigation and subsequent treatment can slow down or even eliminate the disease from the body.  But she notes that when misdiagnosis arises from clinical or technical error, the patient can suffer traumatic consequences because of complications.

Ajayi, in a paper entitled; “Medical Testing,” during a seminar on Medical Laboratory and its Significance in Modern Medical Practice” organised by PathCare, Nigeria, explained that accurate laboratory test before treatment would eliminate misdiagnosis and improve life expectancy.

Highlighting the importance of early testing and treatment to save lives of patients, she cautioned that every drug has dual function and self medication should not in any way be encouraged because “in treatment, no matter whatever you are treating, it treats the body as a whole”.

According to her: “Laboratory tests are very essential because no drug is absolutely safe. Self diagnosis only treats symptoms and not the problem. There is need for patients to take ownership of their body and object when doctors do not carry out laboratory tests before treating them ”

However, the state of Nigeria laboratories has become worrisome.  Inability of most scientists to diagnose properly due to lack of equipment has been implicated in the poor state of laboratory results in the country, hence the need to invest in upgrading laboratories to meet world standard.

Today in Nigeria, ISO accredited medical laboratories are hard to come by.

To ensure quality and quality assurance in Nigeria laboratories, Professor Ibironke Akinsete, Chairman, Board of Trustees, PathCare, who lamented that the consequences of wrong diagnosis have led to deaths of patients said “There is need to get what would ensure that patients have the right results at any time.  Quality control measures should be put in place to ensure that each test is done according to set standards.

On her part, Dr. Pamela Ajayi who also spoke on the advantages of testing, explained further that PathCare which is currently the only ISO Accredited Medical Laboratory in Nigeria, is poised to improve the efficacy of diagnostic medicine, compliments the technology deficiency in the tertiary hospitals, avail doctors the opportunity of practicing EBM and bridge the gap between Nigeria and other countries as well as engender trust in doctors request for quality laboratory results.

Akinsete described quality assurance as overall programme that ensures that the final results reported by the laboratory are accurate.  Unfortunately in Nigeria, 90 percent of laboratories in Nigeria cannot boast of internal quality control which has become the bane of accurate laboratory results in Nigeria.

According to Akinsete, Most laboratories in Nigeria have inadequate trained personnel, poor reagent equipment among others and this has made laboratory results from Nigeria unacceptable abroad.

To improve the laboratory results, there is need to put in place standards operating procedure that everybody must follow. There should be regular audits to ensure that standards are maintained. Pathology supervision is also necessary.

To put an end to patient doubts and medical tourism, Akinsete further noted that there  is also the need for Laboratories to be accredited by recognised bodies to ensure that they meet minimum quality management standards.

Other experts say for the country to have a quality laboratory results as well as improve the quality of clinical care there is need to raise the profile of laboratories in the country.

Nigerian situation Only estimated 300 pathologists are serving 140 million people. A situation experts say could be a major risk as when overworked. Tired pathologists are more likely to make wrong diagnoses. Even when there are very good quality systems in place to try to prevent these mistakes in such environments are much more likely.

Dr. Oyetunji Soriyan, a Consultant Clinical Pathologist, College of Medicine University of Lagos, and Lagos University Teaching Hospital, LUTH, described pathology as a critical part of the medical process. “Without high quality pathology services, healthcare would degenerate and services could eventually grind to a halt”.

But despite the critical role pathologists and pathology play in medicine, very few people understand what pathology is all about. They play an important role in diagnosing and monitoring diseases such as diabetes and rheumatoid arthritis. They play an integral role in blood transfusion services and they are at the cutting edge of using genetics in diagnosing disease.

More than 70 per cent of all diagnoses will involve pathology tests. Add to that the important role pathology plays in monitoring disease, and it is all too apparent why this profession is so critical unfortunately, Nigeria is in crisis in that aspect.

Way forward

Prof. Sade Ogunsola, Consultant Clinical Microbiologist, College of Medicine, University of Lagos, in her paper, “Challenges in Nigeria,” identified perceptions as one of the factors fueling poor laboratory results. According to her, most Nigerian patients see laboratory testing as last resort after self medication.

There is need for Nigerians to change their perceptions and unfortunately, government  at all levels do not see laboratory medicine as priority”, she added.

“In the last two decades, the laboratories in Nigeria have been allowed to degenerate so bad. There have been poor infrastructures both in private and public, no clear definition of job descriptions for the different professions within the facilities.

No clear policy and guidelines on the management and leadership of facilities, lack of internationally adopted standards that encompass all professionals and no intentionally accreditation and monitoring system amongst others have continued to plague the system.

Ogunsola who lamented that only 25 per cent of people who think they have malaria, has malaria opined that awareness is the key to reversing the trend in Nigeria.

How a second medical opinion saved my life  – Victim of misdiagnosis

Importance of timely and accurate testing cannot be over emphasised.  Many patients have faced various complications due to late and inaccurate testing.  Many patients have died out of medical error while others injured due poor quality diagnosis.

Ms. Stella Emmanuel almost lost her life due to wrong diagnosis abinitio. But thanks to God as timely and accurate testing also saved her life the second time.

Sharing her testimony with Sunday Health Report shortly after a seminar organised by PathCare, “Nigeria on Medical Laboratory Testing and Its Significance in Modern Medical Practice” in Lagos, she said “If I had been diagnosed earlier, there would have been no need for the kidney transplant.

But Stella was grateful that, timely and accurate testing saved her life the second time, when her body showed signs of kidney rejection.It all started when she was showing signs of malaria and was treated.  Unfortunately, the suspected malaria case resulted to kidney failure due to unreliable results from the laboratory. Excerpts:

“If you live within this region, you will always have some strains of malaria in your bloodstream. When I started showing signs of malaria, I was tested and treatment for malaria. After the usual cause of treatment, I did not get any better. I was asked to do more testing”.

After the second level of testing, which showed that she had typhoid fever, Stella became alarmed.

According to her, she found the result a bit strange as she was always particular of what she eats.

“I found that very strange, because I thought the source of typhoid fever is from the food and water you are getting. I am very particular of where and how I eat.” Desperate about her health, she never rejected the result.  She was treated for typhoid but she never got  better.

At this point, Stella started wondering, “In all  of this, I was like, what is exactly going on? I started asking what was going on. To cut the long story short, the doctors came to me again, and said: ‘From the result of the test we have done now, it looks like your kidneys are failing.”

I was thinking that at what point could this have been this discovered?  Probably that should have been stopped. Eventually, it was true that my kidneys were failing. So, I traveled abroad. And there it was confirmed that both kidneys had actually failed and I had to be on long time kidney dialysis just  to stay alive.”

Stressing the importance of timely and accurate testing from her experience, she said: “While you are on dialysis, testing is key and it is fundamental to the success of your dialysis. While you are on dialysis, you need to know how you are reacting, the toxins, etc. And that just goes to underscore the fact that  you really can’t run away from timing and accurate testing.”

However, Stella was able to have her kidney transplant done last year which saved her  the stress of going to the hospital for dialysis three times a week.

“To ensure that I did not have rejection of the kidney, I was placed on regular testing, a timely and  accurate testing for that matter.  I had my transplant done in May. I was still under management.  One day in  August, I was called by the doctors, then I went for check up.  After seeing the doctors, I left.

Few hours later, the doctors I saw earlier in the day called and said, Stella you have to come back to the hospital now. I said, today is my mother’s birthday. Can I come in tomorrow? They said no. They insisted I must come that very minute and I packed my bag and went back to the hospital. I was admitted.

It so happened, that the rejection was on. My body was showing signs of rejection. They were able to do an accurate test and the result was received timely. I was called back to the hospital, quickly changed the drugs and treated the signs. Now, I am okay and stable.

From her experience, she was made to understand the importance of  testing during, pre, post medical.  “Timing is very important and the quality also counts.