Women and Minorities Bear the Brunt of Medical Misdiagnosis
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Charity Watkins sensed something was deeply wrong when she experienced exhaustion after her daughter was born.
At times, Watkins, then 30, had to stop on the stairway to catch her breath. Her obstetrician said postpartum depression likely caused the weakness and fatigue. When Watkins, who is Black, complained of a cough, her doctor blamed the flu.
About eight weeks after delivery, Watkins thought she was having a heart attack, and her husband took her to the emergency room. After a 5½-hour wait in a North Carolina hospital, she returned home to nurse her baby without seeing a doctor.
When a physician finally examined Watkins three days later, he immediately noticed her legs and stomach were swollen, a sign that her body was retaining fluid. After a chest X-ray, the doctor diagnosed her with heart failure, a serious condition in which the heart becomes too weak to adequately pump oxygen-rich blood to organs throughout the body. Watkins spent two weeks in intensive care.
She said a cardiologist later told her, “We almost lost you.”
Watkins is among 12 million adults misdiagnosed every year in the U.S.
In a study published Jan. 8 in JAMA Internal Medicine, researchers found that nearly 1 in 4 hospital patients who died or were transferred to intensive care had experienced a diagnostic error. Nearly 18% of misdiagnosed patients were harmed or died.
In all, an estimated 795,000 patients a year die or are permanently disabled because of misdiagnosis, according to a study published in July in the BMJ Quality & Safety periodical.
Some patients are at higher risk than others.
Women and racial and ethnic minorities are 20% to 30% more likely than white men to experience a misdiagnosis, said David Newman-Toker, a professor of neurology at Johns Hopkins School of Medicine and the lead author of the BMJ study. “That’s significant and inexcusable,” he said.
Researchers call misdiagnosis an urgent public health problem. The study found that rates of misdiagnosis range from 1.5% of heart attacks to 17.5% of strokes and 22.5% of lung cancers.
Weakening of the heart muscle — which led to Watkins’ heart failure — is the most common cause of maternal death one week to one year after delivery, and is more common among Black women.
Heart failure “should have been No. 1 on the list of possible causes” for Watkins’ symptoms, said Ronald Wyatt, chief science and chief medical officer at the Society to Improve Diagnosis in Medicine, a nonprofit research and advocacy group.
Maternal mortality for Black mothers has increased dramatically in recent years. The United States has the highest maternal mortality rate among developed countries. According to the Centers for Disease Control and Prevention, non-Hispanic Black mothers are 2.6 times as likely to die as non-Hispanic white moms. More than half of these deaths take place within a year after delivery.
Research shows that Black women with childbirth-related heart failure are typically diagnosed later than white women, said Jennifer Lewey, co-director of the pregnancy and heart disease program at Penn Medicine. That can allow patients to further deteriorate, making Black women less likely to fully recover and more likely to suffer from weakened hearts for the rest of their lives.
Watkins said the diagnosis changed her life. Doctors advised her “not to have another baby, or I might need a heart transplant,” she said. Being deprived of the chance to have another child, she said, “was devastating.”
Racial and gender disparities are widespread.
Women and minority patients suffering from heart attacks are more likely than others to be discharged without diagnosis or treatment.
Black people with depression are more likely than others to be misdiagnosed with schizophrenia.
Minorities are less likely than whites to be diagnosed early with dementia, depriving them of the opportunities to receive treatments that work best in the early stages of the disease.
Misdiagnosis isn’t new. Doctors have used autopsy studies to estimate the percentage of patients who died with undiagnosed diseases for more than a century. Although those studies show some improvement over time, life-threatening mistakes remain all too common, despite an array of sophisticated diagnostic tools, said Hardeep Singh, a professor at Baylor College of Medicine who studies ways to improve diagnosis.
“The vast majority of diagnoses can be made by getting to know the patient’s story really well, asking follow-up questions, examining the patient, and ordering basic tests,” said Singh, who is also a researcher at Houston’s Michael E. DeBakey VA Medical Center. When talking to people who’ve been misdiagnosed, “one of the things we hear over and over is, ‘The doctor didn’t listen to me.’”
Racial disparities in misdiagnosis are sometimes explained by noting that minority patients are less likely to be insured than white patients and often lack access to high-quality hospitals. But the picture is more complicated, said Monika Goyal, an emergency physician at Children’s National Hospital in Washington, D.C., who has documented racial bias in children’s health care.
In a 2020 study, Goyal and her colleagues found that Black kids with appendicitis were less likely than their white peers to be correctly diagnosed, even when both groups of patients visited the same hospital.
Although few doctors deliberately discriminate against women or minorities, Goyal said, many are biased without realizing it.
“Racial bias is baked into our culture,” Goyal said. “It’s important for all of us to start recognizing that.”
Demanding schedules, which prevent doctors from spending as much time with patients as they’d like, can contribute to diagnostic errors, said Karen Lutfey Spencer, a professor of health and behavioral sciences at the University of Colorado-Denver. “Doctors are more likely to make biased decisions when they are busy and overworked,” Spencer said. “There are some really smart, well-intentioned providers who are getting chewed up in a system that’s very unforgiving.”
Doctors make better treatment decisions when they’re more confident of a diagnosis, Spencer said.
In an experiment, researchers asked doctors to view videos of actors pretending to be patients with heart disease or depression, make a diagnosis, and recommend follow-up actions. Doctors felt far more certain diagnosing white men than Black patients or younger women.
“If they were less certain, they were less likely to take action, such as ordering tests,” Spencer said. “If they were less certain, they might just wait to prescribe treatment.”
It’s easy to see why doctors are more confident when diagnosing white men, Spencer said. For more than a century, medical textbooks have illustrated diseases with stereotypical images of white men. Only 4.5% of images in general medical textbooks feature patients with dark skin.
That may help explain why patients with darker complexions are less likely to receive a timely diagnosis with conditions that affect the skin, from cancer to Lyme disease, which causes a red or pink rash in the earliest stage of infection. Black patients with Lyme disease are more likely to be diagnosed with more advanced disease, which can cause arthritis and damage the heart. Black people with melanoma are about three times as likely as whites to die within five years.
The covid-19 pandemic helped raise awareness that pulse oximeters — the fingertip devices used to measure a patient’s pulse and oxygen levels — are less accurate for people with dark skin. The devices work by shining light through the skin; their failures have delayed critical care for many Black patients.
Seven years after her misdiagnosis, Watkins is an assistant professor of social work at North Carolina Central University in Durham, where she studies the psychosocial effects experienced by Black mothers who survive severe childbirth complications.
“Sharing my story is part of my healing,” said Watkins, who speaks to medical groups to help doctors improve their care. “It has helped me reclaim power in my life, just to be able to help others.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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An Unexpected Extra Threat Of Alcohol
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If You Could Use Some Exotic Booze…
…then for health reasons, we’re going to have to say “nay”.
We’ve written about alcohol before, and needless to say, it’s not good:
(the answer is “no, we cannot”)
In fact, the WHO (which unlike government regulatory bodies setting “safe” limits on drinking, makes no profit from taxes on alcohol sales) has declared that “the only safe amount of alcohol is zero”:
WHO: No level of alcohol consumption is safe for our health
Up there, where the air is rarefied…
If you’re flying somewhere this summer (Sinatra-style flying honeymoon or otherwise), you might want to skip the alcohol even if you normally do imbibe, because:
❝…even in young and healthy individuals, the combination of alcohol intake with sleeping under hypobaric conditions poses a considerable strain on the cardiac system and might lead to exacerbation of symptoms in patients with cardiac or pulmonary diseases.
These effects might be even greater in older people; cardiovascular symptoms have a prevalence of 7% of inflight medical emergencies, with cardiac arrest causing 58% of aircraft diversions.❞
Source: Alcohol plus cabin pressure at higher altitude may threaten sleeping plane passengers’ heart health
The experiment divided subjects into a control group and a study group; the study group were placed in simulated cabin pressure as though at altitude, which found, when giving some of them two small(we’re talking the kind given on flights) alcoholic drinks:
❝The combination of alcohol and simulated cabin pressure at cruising altitude prompted a fall in SpO2 to an average of just over 85% and a compensatory increase in heart rate to an average of nearly 88 beats/minute during sleep.❞
In contrast, that was 77 beats/minute for those who had alcohol but weren’t at altitude pressure, or 64 beats/minute for those who neither drank nor were at altitude pressure.
Lots more metrics were recorded and the study is interesting to read; if you’ve ever slept on a plane and thought “that sleep was not restful at all”, then know: it wasn’t just the seat’s fault, nor the engine, nor the recycled nature of the air—it was the reduced pressure causing hypoxia (defined as having oxygen levels lower than the healthy clinical norm of 90%) and almost halving your sleep’s effectiveness for a less than 10% drop in available oxygen in the blood (the sleepers not at altitude pressure averaged 96% SpO2, compared to the 85% at altitude).
We say “almost halving” because the deep sleep phase of sleep was reduced from 84 minutes (control) to 67.5 minutes at altitude without alcohol, or 46.5 minutes at altitude with alcohol.
Again, this was a pressure cabin in a lab—so this wasn’t about the other conditions of an airplane (seats, engine hundreds of other people, etc).
Which means: in an actual airplane it’s probably even worse.
Oh, and the study participants? All healthy individuals aged 18–40, so again probably worse for those older (or younger) than that range, or with existing health conditions!
Want to know more?
You can read the study in full here:
Want to drop the drink at any altitude? Check out:
Want to get that vacation feel without alcohol? You’re going to love:
Mocktails – by Moira Clark (book)
Enjoy!
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10 Ways To Balance Blood Sugars
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“Let Them Eat Cake”, She Said…
This is Jessie Inchauspé, a French biochemist and author. She’s most known for her best-selling “Glucose Revolution: The Life-Changing Power Of Balancing Your Blood Sugar”.
It’s a great book (which we reviewed recently) and you absolutely should read it, but meanwhile, we’re going to distill at least the most critical core ideas, 10almonds style. In this case, her “ten hacks”:
Eat foods in the right order
The order is:
- Fiber first
- Protein and fat second
- Starches and sugars last
What happens here is… the fiber perks up the gut bacteria, the protein and fat will then be better-digested next, and the starches and sugars will try to jump the line, but they can’t because the fiber is a physical speedbump and the proteins and fats are taking the prime place for being digested. So instead, the starches and sugars—usually responsible for blood sugar spikes—get processed much more gradually, resulting in a nice even curve.
Add a green starter to all your meals
We know what you’re thinking: “that’s just the first one again”, but no. This is an extra starter, before you get to that. If you’re the cook of the household, this can absolutely simply mean snacking on green ingredients while cooking.
Stop counting calories
Especially, she advises: stop worrying about extra calories from fats, such as if doing an oil-and-vinegar dressing for salad—which she also recommends, because all three components (the oil, the vinegar, and the salad) help even out blood sugar levels.
Flatten your breakfast curve
For many, breakfast is the starchiest meal of the day, if not the sugariest. Inchauspé recommends flipping this (ideally) or softening it (if you really must have a carb-based breakfast):
- Top choices include: a warm vegetable salad, fish, or eggs (or tofu if you don’t do animal products).
- Next-best include: if you must have toast, make sure to have butter (and/or the aforementioned egg/tofu, for example) to give your digestion an extra thing to do.
- Also: she recommends skipping the juice in favour of home-made breakfast smoothies. That way, instead of basically just sugar with some vitamins, you’re getting a range of nutrients that, if you stack it right, can constitute a balanced meal itself, with fiber + protein + fat + carbs.
As an extra note from the 10almonds team: come to think of it, today’s sponsor’s product would be a great choice for this “mixed nutrient breakfast” idea! But more on that later
Have any type of sugar—they’re all the same
They’re technically not, but the point is that your body will immediately take them apart and then they will be just the same. Whether it’s the cheapest white sugar or the most expensive organic lovingly hand-reared free-range agave nectar, your body is going to immediately give it the chop-shop treatment (a process so quick as to be practically instantaneous) and say “this is now glucose”.
Pick a dessert over a sweet snack
Remember that about the right order for foods? A dessert, when your body is already digesting dinner, is going to make much less of a glucose spike than, say, a blueberry muffin when all you’ve had this morning is coffee and juice.
Reach for the vinegar before you eat
We recently did a whole main feature about this, so we’ll not double up today!
After you eat, move
The glucose you eat will be used to replace lost muscle glycogen, before any left over is stored as fat… and, while it’s waiting to be stored as fat, just sitting in your bloodstream being high blood sugars. So, this whole thing will go a lot better if you are actively using muscle glycogen (by moving your body).
Inchauspé gives a metaphor: imagine a steam train worker, shoveling coal into the furnace. Meanwhile, other workers are bringing more coal. If the train is moving quickly, the coal can be shoveled into the furnace and burned and won’t build up so quickly. But if the train is moving slowly or not at all, that coal is just going to build up and build up, until the worker can shovel no more because of being neck-deep in coal.
Same with your blood sugars!
If you want to snack, go low-sugar
In the category of advice that will shock nobody: sugary snacks aren’t good for avoiding blood sugar spikes! This one probably didn’t need a chapter devoted to it, but anyway: low sugar is indeed the way to go for snacks.
Put some clothes on your carbs
This is about olive oil on pasta, butter on potatoes, and so forth. Basically, anything starchy is going to be broken down quickly to sugar and sent straight into the bloodstream, if there’s nothing to slow it down. If you’re wondering what to do with rice: adding a tablespoon of chia seeds to the rice while cooking (so they’re cooked together) will add very healthy fats to your rice, and (because they’ve been cooked) will not seem like eating seeds, by the way. In terms of texture and appearance, it’ll be as though you threw some black pepper in*
*which you should also do for many reasons, but that’s beyond the scope of this “about blood sugars” feature!
Wanting to know more about the science of this?
We’ve done all we have room for here today, but Inchauspé is, as ever, happy to explain it herself:
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Staying Alive – by Dr. Jenny Goodman
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A lot of “healthy long life” books are science-heavy to the point of being quite challenging to read—they become excellent reference sources, but not exactly “curl up in the armchair” books.
Dr. Goodman writes in a much more reader-friendly fashion, casual yet clear.
She kicks off with season-specific advice. What does that mean? Basically, our bodies need different things at different times of year, and we face different challenges to good health. We may ignore such at our peril!
After a chapter for each of the four seasons (assuming a temperate Northern Hemisphere climate), she goes on to cover the seasons of our life. Once again, our bodies need different things at different times in our life, and we again face different challenges to good health!
There’s plenty of “advice for all seasons”, too. Nutritional dos and don’t, and perennial health hazards to avoid.
As a caveat, she does also hold some unscientific views that may be skipped over. These range from “plant-based diets aren’t sustainable” to “this detox will get rid of heavy metals”. However, the value contained in the rest of the book is more than sufficient to persuade us to overlook those personal quirks.
In particular, she offers very good advice on overcoming cravings (and distinguishing them from genuine nutritional cravings), and taking care of our “trillions of tiny companions” (beneficial gut microbiota) without nurturing Candida and other less helpful gut flora and fauna.
In short, a fine lot of information in a very readable format.
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Lime-Charred Cauliflower Popcorn
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Called “popcorn” for its appearance and tasty-snackness, this one otherwise bears little relation to the usual movie theater snack, and it’s both tastier and healthier. All that said, it can be eaten on its own as a snack (even with a movie, if you so wish), or served as one part of a many-dish banquet, or (this writer’s favorite) as a delicious appetizer that also puts down a healthy bed of fiber ready for the main course to follow it.
You will need
- 1 cauliflower, cut into small (popcorn-sized) florets
- 2 tbsp extra virgin olive oil
- 1 tbsp lime pickle
- 1 tsp cumin seeds
- 1 tsp smoked paprika
- 1 tsp chili flakes
- 1 tsp black pepper, coarse ground
- ½ tsp ground turmeric
Method
(we suggest you read everything at least once before doing anything)
1) Preheat your oven as hot as it will go
2) Mix all the ingredients in a small bowl except the cauliflower, to form a marinade
3) Drizzle the marinade over the cauliflower in a larger bowl (i.e. big enough for the cauliflower), and mix well until the cauliflower is entirely, or at least almost entirely, coated. Yes, it’s not a lot of marinade but unless you picked a truly huge cauliflower, the proportions we gave will be enough, and you want the end result to be crisp, not dripping.
4) Spread the marinaded cauliflower florets out on a baking tray lined with baking paper. Put it in the oven on the middle shelf, so it doesn’t cook unevenly, but keeping the temperature as high as it goes.
5) When it is charred and crispy golden, it’s done—this should take about 20 minutes, but we’ll say ±5 minutes depending on your oven, so do check on it periodically—and time to serve (it is best enjoyed warm).
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- We must do a main feature on the merits of cruciferous vegetables! Watch this space.
- All About Olive Oils (Extra Virgin & Otherwise)
- Capsaicin For Weight Loss And Against Inflammation
- Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
- Why Curcumin (Turmeric) Is Worth Its Weight In Gold
Take care!
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How to Fall Asleep Faster: CBT-Insomnia Treatment
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Insomnia affects a lot of people, and is even more common as we get older. Happily, therapist Emma McAdam is here with a drug-free solution that will work for most people most of the time.
Cognitive Behavioral Therapy for Insomnia (CBTI)
While people think of causes of insomnia as being things such as stress, anxiety, overthinking, disturbances, and so forth, these things affect sleep in the short term, but don’t directly cause chronic insomnia.
We say “directly”, because chronic insomnia is usually the result of the brain becoming accustomed to the above, and thus accidentally training itself to not sleep.
The remedy: cut the bad habit of staying in bed while awake. Lying in bed awake trains the brain to associate lying in bed with wakefulness (and any associated worrying, etc). In essence, we lie down, and the brain thinks “Aha, we know this one; this is the time and place for worrying, ok, let’s get to work”.
So instead: if you’re in bed and not asleep within 15 minutes, get up and do something non-stimulating until you feel sleepy, then return to bed. This may cause some short term tiredness, but it will usually correct the chronic insomnia within a week.
For more details, tips, and troubleshooting with regard to the above, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
How to Fall Back Asleep After Waking Up in the Middle of the Night
Take care!
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Tranquility by Tuesday?
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I Know How She Does It: How Successful Women Make The Most of Their Time
This is Laura Vanderkam, author of “Tranquility By Tuesday” (amongst other books). Her “thing” is spending more time on what’s important, and less on what isn’t. Sounds simple, but she’s made a career out of it, so condensed here for you are…
Laura’s 7 Keys To Productivity
Key One: Plan your weeks on Fridays
You don’t want your Monday morning to be a “James Bond intro” (where everything is already in action and you’re just along for the ride, trying to figure out what’s going on). So, take some time last thing each Friday, to plan ahead for the following week!
Key Two: Measure what matters
Whatever that means to you. Laura tracks her use of time in half-hour blocks, and likes keeping track of streaks. For her, that means running daily and keeping a log of it. She also keeps track of the books she reads. For someone else it could be music practice, or a Duolingo streak, or eating fruit each day.
On which note…
“Dr. Greger’s Daily Dozen” is simpler than most nutrition trackers (where you must search for everything you eat, or scan barcodes for all ingredients).
Instead, it keeps track of whether you are having certain key health-giving foods often enough to maintain good health.
We might feature his method in a future edition of 10almonds, but for now, check the app out for yourself here:
Get Dr. Greger’s Daily Dozen on iOS / Get Dr. Greger’s Daily Dozen on Android
Dr. Greger’s Daily Dozen @ Nutrition Facts
Key Three: Figure out 2–3 “anchor” events for the weekend
Otherwise, it can become a bit of a haze and on Monday you find yourself thinking “where did the weekend go?”. So, plan some stuff! It doesn’t have to be anything out-of-this-world, just something that you can look forward to in advance and remember afterwards. It could be a meal out with your family, or a session doing some gardening, or a romantic night in with your partner. Whatever makes your life “living” and not passing you by!
Key Four: Tackle the toughest work first
You’ve probably heard about “swallowing frogs”. If not, there are various versions, usually attributed to Mark Twain.
Here’s one:
“If it’s your job to eat a frog, it’s best to do it first thing in the morning. And if it’s your job to eat two frogs, it’s best to eat the biggest one first.”
Top Productivity App “ToDoist” has an option for this, by the way!
Laura’s key advice here is: get the hard stuff done now! Before you get distracted or tired and postpone it to tomorrow (and then lather rinse repeat, so it never gets done)
10almonds Tip:
“But what if something’s really important but not as pressing as some less important, but more urgent tasks?”
Simple!
Set a timer (we love the Pomodoro method, by the way) and do one burst of the important-but-not-urgent task first. Then you can get to the more urgent stuff.
Repeat each day until the important-but-not-urgent task is done!
The 10almonds Team
Key Five: Use bits of time well
If, like many of us, you’ve a neverending “to read” list, use the 5–10 minute breaks that get enforced upon us periodically through the day!
- Use those few minutes before a meeting/phonecall!
- Use the time you spend waiting for public transport or riding on it!
- Use the time you spent waiting for a family member to finish doing a thing!
All those 5–10 minute bits soon add up… You might as well spend that time reading something you know will add value to your life, rather than browsing social media, for example.
Key Six: Make very short daily to-do lists
By “short”, Laura considers this “under 10 items”. Do this as the last part of your working day, ready for tomorrow. Not at bedtime! Bedtime is for winding down, not winding up
Key Seven: Have a bedtime
Laura shoots for 10:30pm, but whatever works for you and your morning responsibilities. Your morning responsibilities aren’t tied to a specific time? Lucky you, but try to keep a bedtime anyway. Otherwise, your daily rhythm can end up sliding around the clock, especially if you work from home!
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