Another anecdote in favor of being an informed patient:

I've always been doctor-averse; usually I only show up when I have a UTI and need some antibiotics. I'm so doctor-averse, in fact, that when I fractured my ankle in college -- badly enough that there was a loud snapping sound and immediate major swelling -- I just wrapped it up with a friend's splint (under the supervision of another friend, who was a nursing student) and went on with my life.

I'd been fairly athletically active prior to that point, but not long after the fracture, my academic and extracurricular responsibilities really amped up, and working out disappeared. I gained some weight. There was lingering pain in the ankle, which of course also dissuaded me from, say, taking up running again.

Finally, a year after I graduated, I had a job where I was on my feet often, and the ankle pain became seriously problematic. I finally went to see a doctor, whose immediate suggestion -- after I explained that I'd fractured it previously and never seen anyone -- was simply to lose weight. I was offended (I'm not exactly 400 pounds; I'm not even 200 pounds, and this guy wasn't exactly in shape himself) and persisted, and he ordered an MRI.

The MRI showed "chronic tenosynovitis". When the doctor reviewed it with me, he told me there was nothing to do for it except regular cortisone shots. He gave me the first shot then and there, and then I went home and Googled the condition to read up on it. What did I learn in about three minutes online? Well, turns out that cortisone shots were once thought to be helpful, but newer research shows that they're more likely to lead to tendon tearing and further complications.

Fortunately I didn't have any tearing -- but man, I never saw that doctor again! And what an experience to validate my doctor-aversion. I've since done further research and found some exercises that have helped with the pain, and which were vastly more helpful than the dismissive doctor who called me fat and shot me up with some steroid that could've led to REAL problems.

Quacks aren't just in alternative medicine. Bad doctors exist -- as another writer pointed out, there's always going to be a bottom 5% of every medical school class! Doctors are only human, and medicine isn't math. Being an informed patient is crucial to getting decent care, even if you have to be pushy to be heard.

from "The Startling Truth About Doctors and Diagnostic Errors," excerpts:

"... doctors misdiagnose patients more often than we would like to think. Sometimes they diagnose patients with illnesses they don't have. Other times, the true condition is missed. All in all, diagnostic errors account for 17 percent of adverse events in hospitals....

"Diagnostic mistakes 'often have complex causal pathways, take time to play out, and may not kill for hours [i.e., if a doctor misses myocardial infarction in a patient], days (missed meningitis) or even years (missed cancers).' In short, to understand diagnostic errors, you need to pay attention for a longer period of time....

"'As quality and safety movements gallop along, the need to address diagnostic errors grows more pressing.... Until we do, we will face a fundamental problem: A hospital can be seen as a high-quality organization... if all of its 'pneumonia' patients receive the correct antibiotics, all its 'CHF' patients are prescribed ACE inhibitors, and all its 'MI' patients get aspirin and beta blockers.... 'Even if every one of the diagnoses was wrong.'

"....Medicine is shot through with uncertainty; diseases do not always present neatly, in textbook fashion, and every human body is unique. These are just a few reasons why diagnosis is, perhaps, the most difficult part of medicine.

"But misdiagnosis almost always can be traced to cognitive errors in how doctors think. When diagnosis is based on simple observation in specialties like radiology and pathology, which rely heavily on visual interpretation, error rates probably range from 2 percent to 5 percent...

"By contrast, in clinical specialties that rely on 'data gathering and synthesis' rather than observation, error rates tend to run as high as 15 percent.'

"...numerous studies show that the rate of misdiagnosis is 'disappointingly high' both 'for relatively benign conditions' and 'for disorders where rapid and accurate diagnosis is essential, such as myocardial infarction, pulmonary embolism, and dissecting or ruptured aortic aneurysms.'

...."Misdiagnosis rarely springs from a 'lack of knowledge per se, such as seeing a patient with a disease that the physician has never encountered before.... More commonly, cognitive errors reflect problems gathering data, such as failing to elicit complete and accurate information from the patient; failure to recognize the significance of data, such as misinterpreting test results; or most commonly, failure to synthesize or "put it all together."

"The breakdown in clinical reasoning often occurs because the physician isn't willing or able to 'reflect on [his] own thinking processes and critically examine [his] assumptions, beliefs, and conclusions.' In a word, the physician is too 'confident.'

...."Overconfidence, or the belief that 'I know all I need to know,' may help explain what the researchers describe as a 'pervasive disinterest in any decision support or feedback, regardless of the specific situation. Studies show that 'physicians admit to having many questions that could be important at the point of care, but which they do not pursue....'

....'In most cases, it wasn't the technology that failed.... Rather, the physician did not consider the right diagnosis in the first place. The perfect test or scan may have been available, but the physician never ordered it.' Instead, he ordered another test -- and believed it.

"...physicians are not simply deceiving themselves,... many honestly don't know when they have misdiagnosed a patient. No one tells them -- including the patient.

"Sometimes a patient who isn't getting better simply leaves the doctor and finds someone else. His original doctor may well assume that he was finally cured. Or the patient may be discharged from the hospital, relapse three months later, and go to a different ER where he discovers that his symptoms have returned because he was, in fact, misdiagnosed.'

...."When [asked] whether they have made a diagnostic error in the past year,... only 1 percent [of physicians] admit to having made such a mistake.'

"Here, we reach the heart of the problem,... 'the remarkable discrepancy between the known prevalence of diagnostic error and physician perception of their own error rate.' This gap 'has not been formally quantified and is only indirectly discussed in the medical literature,... but [it] lies at the crux of the diagnostic error puzzle....'

"At one time, autopsies provided physicians with the information they needed. And the results were regularly discussed at 'mortality and morbidity' conferences, where doctors [discussed] what they could have done differently.

"But today, 'autopsies are done in 10 percent of all deaths; many hospitals do none.... This is a dramatic turnabout. Throughout much of the 20th century, doctors diligently obtained autopsies in the majority of all deaths....

"'So what accounts for the decline?... to judge from recent studies, [families] still grant... permission up to 80 percent of the time. Instead, doctors... have simply stopped asking....

"Between 1972 and 1995, the last year for which statistics are available, the rate fell from 19.1 percent of all deaths to 9.4 percent. A major reason for the decline over this period is that 'imaging technologies such as CT scanning and ultrasound have enabled doctors to 'see' such obvious internal causes of death.... Nowadays an autopsy seems a waste of time and resources.

"'Today we have MRI scans, ultrasound, nuclear medicine, molecular testing and much more. When somebody dies, we already know why. We don't need an autopsy to find out ... Or so I thought ... ' Gawande then goes on to tell the story of a autopsy that rocked him. He had completely misdiagnosed a patient.

...."The autopsy has been described as 'the most powerful tool in the history of medicine' and the 'gold standard' for detecting diagnostic errors,... [and] three studies done in 1998 and 1999 reveal that autopsies 'turn up a major misdiagnosis in roughly 40 percent of all cases.'

"A large review of autopsy studies concluded that, 'in about a third of the misdiagnoses, the patients would have been expected to live if proper treatment had been administered.... [And] the rate at which misdiagnosis is detected in autopsy studies [has] not improved since at least 1938.'

http://www.alternet.org/healthwellness/88515/?page=1