David N. Damick
Brain Tumor Diagnosed as "Anxiety"
How Doctors Make Serious Mistakes and How to Avoid Them!
The 12-year-old suddenly began acting "strange and nervous" as if in a panic. Then in a minute he was back to normal. Then it happened again a few months later. The family described the seizure-like episodes - always limited to about a minute - to their pediatrician, who said it was said it was panic attacks due to the "little angst" that all children have. He recommended deep breathing and going for walks. Over the next six years, these episodes became more frequent, and then in clusters, several in one day and then a few days break. Although the attacks interrupted him in his games and schoolwork, he was otherwise well. His mother repeatedly asked the pediatrician about it, at least "sixty times" she recalls, but each time the doctor insisted it was stress and recommended counseling and refused over that entire time to order other tests or refer this teen to a neurologist. Finally, his mother took the teen to an adult neurologist who recommended a pediatric neurologist. But when the pediatric neurologist heard that the pediatrician had diagnosed panic attacks, she stopped and went no further. The teen was dragged to counseling for two years, costing thousands of dollars, and doing no good. In desperation, his mother demanded the doctors perform an MRI, and the reluctant doctor finally allowed it. The MRI found a tumor. The tumor was removed, the seizures left, and the teen is now well as a junior in college.
This true story was recently reported by the Society to Improve Diagnosis in Medicine, as part of a discussion on how doctors get stuck in their wrong diagnosis and refuse to change. Physicians often will "anchor" their opinions to their first thought or idea. This stops them from considering other possible causes. Doctors also may "prematurely close" their investigation - that is they select one diagnosis before ruling out others that may cause the same symptoms. This can be devastating as shown by a case our office handled that was very similar.
Our teen client came to the ER with confusion and "feeling off." He waited for over an hour in a jammed waiting room filled with people with a flu-like illness going around. When he was finally seen, the Emergency Room doctor diagnosed the flu, and sent him home with some feel-better medicine and instructions to rest. A few hours later, his girlfriend brought him back in. He couldn’t drive himself, he was staggering, and he had light flashes before his eyes. The ER doctor again told him he had the flu and sent him home. A third time he returned. This time, he walked right into the wall when the nurse directed him down a hall, and the doctor again told him he had the flu and told him not to come back. Then his mother took action. She brought her son back to that ER and demanded he be seen by a neurologist and made it clear she wasn't leaving until that happened. It did, and the neurologist immediately detected a softball sized tumor at the base of the young man's skull.
What can you do? If your teen or child is not improving, get a second opinion. Ask friends or family for a doctor in another practice - that is someone with "fresh eyes" not tied to supporting the original diagnosis. If your doctor refuses to help with a second opinion, you need a new doctor. Trust your gut, and don't give up. Teens and children may not report all their symptoms. They are private and not sure what they should or should not say. You could also use some of the on-line sources for preparing for a doctor visit, such as the SIDM Patient Toolkit, free here: https://www.improvediagnosis.org/patients-toolkit/.
And, if the delay in diagnosis causes harm to your child, spouse or you, you can call us. Anytime.