A Diagnosis of Misdiagnosis

I was saddened to read Ms. Bauer’s article, and am somewhat relieved that in this instance most of the effects of misdiagnoses and poor management appear to be temporary. I am one of the psychiatrists who was featured in Gardiner Harris’s New York Times article [“After Sanctions, Doctors Get Drug Company Pay,” New York Times, June 3, 2007] referenced by Ms. Bauer.

As I review her story, the major problems that I see in her son’s care are the failure to attribute his changing “symptoms” to the antidepressant, and the subsequent misdiagnosis of the changes as a spontaneous psychosis, hence the addition of the neuroleptics (antipsychotics). I doubt that pharmaceutical company influence led to the antidepressant prescription or to the addition of an antipsychotic when the clinical picture changed. I do feel that failure to see a pattern of side effects was a major problem.

Much of the money paid by pharmaceutical companies to physicians is for pharmaceutical-sponsored educational programs. Much of this is about illness recognition and how to make a correct diagnosis, and is often “unbranded” (in many talks specific medication brands are not mentioned). Paradoxically, pharmaceutical company-sponsored education for health care professionals hopefully will decrease the frequency of similar disasters happening to other patients by increasing MDs knowledge about diagnosis, appropriate treatment, and recognition of side effects.

In this instance, the problem is knowledge, not influence. Mayo Clinic doctors did a fantastic job in this situation, but many MDs who avoid drug company contact end up ten years behind in education about when to use—or avoid—treatments.