Saturday, February 25, 2006

Why do newspapers so often get it wrong?

There’s been some fallout from the New York Times article this week on misdiagnosis. Evidently the NYT got wind of their error of describing a case of necrotizing fasciitis as a flesh eating virus. Although they published no acknowledgement of the error, at least that I can find, they’ve changed the wording of the web version to read “flesh eating infection.” They were so sneaky about it that I began to doubt the accuracy of my own reporting. Had it really said virus? I tried Google’s cache and the Wayback Machine to no avail.

Finally I found a paste of the original version on the UCSF Emergency Medicine List where there is a lively thread. Indeed the original NYT version described the flesh eating infection as a virus. Several doctors on the UCSF list object to the article’s comparison of health care to the airline industry. One writer, Bob Solomon, said “Airplanes are machines. Patients and their families are people. Comparisons are absurd.”

What Isabel Maude, the girl with the flesh eating infection, actually had was chicken pox complicated by Group A Streptococcal necrotizing fasciitis and toxic shock syndrome. DB weighed in and one of his commenters made a good point about necrotizing fasciitis. He said “I can’t believe that the NYT could not come up with a better example of ‘misdiagnosis’ than that. The kid DID have chicken pox, complicated by necrotizing fascitis (a bacteria Ms. New York Times reporter, not a virus). This was an example of incomplete diagnosis, not misdiagnosis. Also, necrotizing fascitis can move incredibly fast, so who is to say that it was present at a detectable stage when the patient first presented.”

Finally, a commenter at Kevin MD questioned the accuracy of autopsy data in assessing diagnostic error: “Finally, because the rate of post-mortem exams is now so low, only cases with some uncertainty are subject to this final check. The application of the post-mortem exam is not a randomly assigned process, but is selected by the presence of strong clinical uncertainty on the part of physicians and/or family.” Well said.

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