Misdiagnosis of Anorectal Problems Common
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Primary care physicians (PCPs) commonly misdiagnose anorectal conditions, such as anal fissures and warts, according to a retrospective study.
In fact, the study revealed that PCPs misdiagnose 70% of anal fissures, 50% of warts, and 40% of fistulas. These problems usually are referred to specialists as "hemorrhoids."
Their success rate is better with abscesses and hemorrhoids, however. In the study, PCPs misdiagnosed these problems 15% and 22% of the time, respectively.
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"These results indicate that more emphasis should be placed on common anorectal conditions in the training of primary care physicians," said Marc Brand, MD, who co-authored the study with Theodore J. Saclarides, MD, both colorectal surgeons at Rush-Presbyterian-St.Luke’s Medical Center in Chicago. Dr. Brand presented his research team’s findings here at the 2000 Annual Meeting of the American Society of Colon and Rectal Surgeons.
He and his colleagues had noted that a large number of patients referred by PCPs to the colorectal surgeons at their center had been inaccurately diagnosed.
, 百拇医药
The researchers reviewed the outpatient records of two colorectal surgeons at the center from July 1996 to July 1999. They selected charts with a final diagnosis (fDx) of hemorrhoids, fissures, fistulas, abscesses, and warts. The team defined a correct diagnosis as agreement between the referring diagnosis (rDx) and the fDx, and defined a correct diagnosis rate as the percentage of accurately referred patients. The researchers defined a misdiagnosis (MisDx) rate as the percentage of treated conditions given an incorrect rDx.
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The patient population consisted of 563 patients with a fDx of hemorrhoids, fissures, fistulas, abscesses and warts.
Internists accounted for 91% of the rDx, whereas family practitioners accounted for 5% and obstetricians/gynecologists, 4%.
Although PCPs can recognize abscesses reliably, the high MisDX rate for the other conditions led the researchers to suggest that colorectal specialists view PCPs’ referring diagnoses with skepticism. "Misdiagnosis by the PCPs may result in delayed or erroneous treatment contributing to suboptimal patient care and rising health care costs," Dr. Brand told Internal Medicine World Report. "Therefore, patients should be referred to the specialists in a timely manner."
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Warren Rudd, MD, director of the Rudd Clinic for Diseases of the Colon and Rectum in Toronto, agreed with Dr. Brand that more emphasis should be placed on common anorectal conditions in the training of PCPs.
"The family physician or even other specialists often do not make the correct initial diagnosis, as they are neither taught nor experienced in this specialty and they do not have the instruments for a proper examination. Therefore, many problems in the anorectal area are labeled as hemorrhoids," Dr. Rudd said. "This study however did not mention anusitis, which is the most frequent anal problem and the most frequently missed; it causes bleeding more often than hemorrhoids."
"Anusitis is a difficult condition to define and therefore confusing to study," Dr. Brand replied., 百拇医药
In fact, the study revealed that PCPs misdiagnose 70% of anal fissures, 50% of warts, and 40% of fistulas. These problems usually are referred to specialists as "hemorrhoids."
Their success rate is better with abscesses and hemorrhoids, however. In the study, PCPs misdiagnosed these problems 15% and 22% of the time, respectively.
, 百拇医药
"These results indicate that more emphasis should be placed on common anorectal conditions in the training of primary care physicians," said Marc Brand, MD, who co-authored the study with Theodore J. Saclarides, MD, both colorectal surgeons at Rush-Presbyterian-St.Luke’s Medical Center in Chicago. Dr. Brand presented his research team’s findings here at the 2000 Annual Meeting of the American Society of Colon and Rectal Surgeons.
He and his colleagues had noted that a large number of patients referred by PCPs to the colorectal surgeons at their center had been inaccurately diagnosed.
, 百拇医药
The researchers reviewed the outpatient records of two colorectal surgeons at the center from July 1996 to July 1999. They selected charts with a final diagnosis (fDx) of hemorrhoids, fissures, fistulas, abscesses, and warts. The team defined a correct diagnosis as agreement between the referring diagnosis (rDx) and the fDx, and defined a correct diagnosis rate as the percentage of accurately referred patients. The researchers defined a misdiagnosis (MisDx) rate as the percentage of treated conditions given an incorrect rDx.
, http://www.100md.com
The patient population consisted of 563 patients with a fDx of hemorrhoids, fissures, fistulas, abscesses and warts.
Internists accounted for 91% of the rDx, whereas family practitioners accounted for 5% and obstetricians/gynecologists, 4%.
Although PCPs can recognize abscesses reliably, the high MisDX rate for the other conditions led the researchers to suggest that colorectal specialists view PCPs’ referring diagnoses with skepticism. "Misdiagnosis by the PCPs may result in delayed or erroneous treatment contributing to suboptimal patient care and rising health care costs," Dr. Brand told Internal Medicine World Report. "Therefore, patients should be referred to the specialists in a timely manner."
, http://www.100md.com
Warren Rudd, MD, director of the Rudd Clinic for Diseases of the Colon and Rectum in Toronto, agreed with Dr. Brand that more emphasis should be placed on common anorectal conditions in the training of PCPs.
"The family physician or even other specialists often do not make the correct initial diagnosis, as they are neither taught nor experienced in this specialty and they do not have the instruments for a proper examination. Therefore, many problems in the anorectal area are labeled as hemorrhoids," Dr. Rudd said. "This study however did not mention anusitis, which is the most frequent anal problem and the most frequently missed; it causes bleeding more often than hemorrhoids."
"Anusitis is a difficult condition to define and therefore confusing to study," Dr. Brand replied., 百拇医药