• Sweden edition

Doctors miss fist-sized brain tumour

Published: 06 Aug 2009 07:50 GMT+02:00
Updated: 06 Aug 2009 07:50 GMT+02:00

A Swedish woman has reported four physicians to a national body that assesses medical negligence after they missed a brain tumour the size of a fist.

One after the other, four physicians in southern Sweden made the same diagnosis: the constant headaches their 27-year-old female patient had been experiencing were due to tension. She was prescribed painkillers to treat the headaches.

Six months later, the original doctor discovered the cause of the pain – a fist-sized tumour in the patient’s frontal lobe. The woman then reported the doctors to the Medical Responsibility Board (Hälso- och sjukvårdens ansvarsnämnd - HSAN), a national authority that assesses medical negligence in Sweden. One of the physicians has received a reprimand.

The doctor in question, who is from Småland, was the last in a long line of those who examined the woman for her severe pain.

According to HSAN, the physician did not sufficiently follow up the woman’s medical history, which would have revealed that the nature of the headaches had changed. In turn, that would have led to an earlier discovery of the tumour.

TT/The Local (news@thelocal.se)

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Your comments about this article

09:08 August 6, 2009 by titousmum
it seems there is one pathetic story a day of the "excellent Swedish medical system" in your paper! You really can collect 'em.

The sad thing is, i guess it doesn't take too much effort to find them...

And very few of these idiots get a reprimand- PLUS the poor bloke who's walkin' around with a tumor the size of the Lincoln Memorial - get's WHAT here?

Absolute BUTKUS!!

This country should be embarrassed - instead I just always find them so damn proud of their "excellent medical care" !


Keep posting them. If nothing, someday I can make wall-paper out of the stories for my guest bathroom!
09:08 August 6, 2009 by Marley420
sounds like a new episode for Homer Simpson...
09:19 August 6, 2009 by Harding00
I have yet to need to go to the doctor in Sweden because I just moved here last December.This same thing can happen back in the US though. Except, if you don't have health insurance (but make to much to get it free, but not enough to pay for insurance, like was my case for a year before moving here) in the US you won't even be able to go to the doctors because of a headache. Sure, the medical examiner will find your brain tumor, but it'll be a tad bit too late. I am not saying there is an excuse for her being told it was merely tension, and I think that the doctors should get reprimanded, fired, fined, whatever. I am not scared of the medical care here in Sweden, just scared of the "get you in and out" (after you wait a long time) way of doing things (or so it seems). I think we, as patients, need to be a little more forceful with doctors, though I think that is very un-Swedish, being forceful.
09:22 August 6, 2009 by peropaco
The woman is probably a foreign resident of Sweden and like in many other cases; Swedish doctors don't administer the same care as they would if the patient was a Svensson, Swenzzon. Go home, take a few Alvidon or Ipren and come back in a couple weeks if the pain persists.
10:15 August 6, 2009 by Kaethar
Is anyone on here a neurologist? -.- That the doctors showed consistency in their diagnoses hint that this tumor was not easy to find. But I guess everyone will fall for a headline. -.- I can't judge this case without more background information.
10:33 August 6, 2009 by DMatni
From my bad experiences with doctors here, I've unfortunately developed a great mistrust for them, especially doctors at the vårdcentral. To be honest, I do think that doctors treat Svenssons and foreigners with the same level of indifference. The only difference is that Swedes are more used to it than we are and it is very un-Swedish to complain or even to visit the doctor for minor symptoms altho I'm not sure what qualifies as minor.

A classic case I've heard is of my friend's husband who was chopping firewood, lost his grip on the axe which then landed on his head and gave him a big, bloody gash. The man refused to go see a doctor, saying all he needs is to clean the gash, take an alvedon and rest for a day. Even his wife thot he was being an idiot but she's Russian. :P Oh he finally did go to the vårdcentral when he got headaches 3 days later and they sent him home, told him to take alvedon and rest for a few days. Typical right?
10:59 August 6, 2009 by Puffin
It's tough but it is impossible for healthcare services to be accurate 100% of the time.

It is very difficult to diagnose brain tumours sometimes - espcially when patient's come in an compalin of vague and diffuse symptoms such as headaches. If they sent everyone who complains of a headache for an MRI scan then the queues will grow to be huge - and those with obvious tumours won't be able to get appointments
11:26 August 6, 2009 by stelmed
I am a medical doctor and I moved to Sweden 2 years ago in order to get my training here. Allow me to give my point of view:

Mistakes in medical practice is a huge problem nowadays. It happens all around the world and unfortunately is one of the leading causes of death for hospitalized people. You can find a well-known study (2001 or 2002) in the very respected JAMA (Journal of American Medical Association) according to which human mistakes is the 4th cause of death in the american hospitals.

In Sweden things are not any different than any other developed country. What maybe happens here is that very often such cases become very popular.

The swedish healthcare system works very well and there are a lot of proofs for that (one of the lowest infant mortality rates in the world, life expectancy in the top group worldwide, rational use of antibiotics, low rate of nosocomial infections and so on).
13:03 August 6, 2009 by Random Guy
Any competent radiologist will tell you that a ~10cm lesion is pretty hard to miss. The article is unclear as to whether any of the four physicians mentioned is a radiologist, but this sort of thing is pretty inexcusable.
13:44 August 6, 2009 by svensson1982
I am a doctor and this case is so ambigious and I believe we shouldn't judge it from this article. There few symptoms that we call them ( red flags ) that when we found them or the patients tell us they have we should be alerted toward something serious!

Not all patients with brain tumours have these flags and not always the headaches mean a tumour. So maybe the doctors have asked her or him all the important questions and the patient denied having these symptoms.

I wonder why the people always jump to attack doctors and blame them immediately. If you think you can do a better job then please go and be a doctor!

But since the socialstyrelsen have decided on the doctors have made mistake then propabley the doctor did a mistake but before starting to hate him ask him how many lives have he saved before missing this case?!!!!!

14:02 August 6, 2009 by Random Guy
@Puffin: you think the queues for MRIs aren't huge now? Recently I tweaked an old injury, for which I'd had surgery several years ago. After going through the vårdguiden nonsense (I was indeed told to take some Ipren and come back in a month, despite telling them I'd already done so on my own for two weeks, to no avail) I finally spoke to an orthopaedist at Sophiahemmet in Stockholm. He said a follow-up MRI was appropriate, and said their first available slot was on 1 July... which would have been fine, except this phone call took place during *the second week of April*. When I mentioned this to a half-dozen Swedish friends and colleagues, they all shrugged their shoulders and said this was quite typical. By comparison, while I was at university in the US, I had three MRIs done (two for the injury, one for an unrelated matter). Despite being on student insurance -- which was universally regarded as being very, very bad there -- I never had to wait more than 10 days for a scan.
16:15 August 6, 2009 by mkvgtired
stelmed, I am not a doctor, but do know how ridiculously complicated the human anatomy is. I am surprised doctors get diagnoses correct as often as they do. Unfortunately with how many tests are required to find uncommon problems misdiagnosis will probably be a problem forever.
16:52 August 6, 2009 by NJGirl
Frontal lobe tumors are notoriously silent, so other than headache there is very little or nothing on examination to suspect a tumor. Problem with this wonderful Swedish socialized medicine is the fact, they do not have enough money to do MRI for every one with the headache. In US every NEW ONSET headache gets the MRI. Maybe 1,000 of them will be negative but 1,001 will save somebody's life by discovering an operable lesion. Sweden does very good job in saving babies ( low infant mortality) and later on lets them die from insufficient diagnostic abilities. Swedish doctors need to sharpen their bedside diagnostic skills and try to spend more time with patients to obtain better history since they do not have the American standart diagnostic backup.
17:26 August 6, 2009 by Hedley
I am a non EU doctor, I am agree with NJGirl!

I know so little about it, however that woman have more chances to survive being in Sweden than US.

It is not as easy as pie suspecting a brain tumor.

I know its signs, and they are very hard to get: Few doctors would look for suckling, Babinski and grasp (I do!)
18:06 August 6, 2009 by Random Guy
@stelmed: In Sweden things are most definitely different than other developed countries. Since you're in the medical profession, why don't you look up the comparative mortality rate for prostate cancer here in Sweden as compared to, say, the US? And as for infant mortality rate, life expectancy, etc. -- Sweden has a relatively small and extremely homogeneous population, which has significant implications on the efficacy of medical care. As a doctor, what specific reasons make you believe this approach would scale to larger countries?

@NJGirl, Hedley: Interesting perspective. I appreciate that this diagnosis could definitely be challenging. But I still think the effective standard of care is much lower here than claimed; too much emphasis on speed rather than quality (see http://www.dn.se/sthlm/snabba-lakare-belonas-med-bonus-1.888110).
20:51 August 6, 2009 by Nilspet
I totally agree with comment #6. This is UNBELIEVABLE. I am surprised why many swedes decide to have medical checkups abroad e.g. in Thailand, Singapore or the UAE when they are on vacation. Swedish medical staff often take them lightly. Doctors here earn quite well but some doctors dont work up to their salary...that is the truth!
22:17 August 6, 2009 by suso
I am a physician.6 months persistent headache in a young lady is surely a cause of concern to her doctor.Headaches lasting for more than 6 weeks make it imperative to exclude a space occuping brain lesion.

Was any proper neurological examinatin done? or was it a speedy,more of a show business,as not infrequently is the case ?

And ,in particular,was proper ophthalmoscopic examination done? for me,as a doctor, if I had any difficulty or suspicion,I would unhesitatingly refer the patient for a speedy ophthalmological opinion.

A fairly large tumor like that would most likely cause retinal changes`,"papilloedoema".

Failure to do neurological examination,including ophthalmoscopy would be inexusable by any standards.
04:16 August 7, 2009 by Omidn
I really don't want to generalize and I admit that misdiagnosis can happen anywhere however this doesn't mean that it is normal to happen even 1%. Since there is no legal liability for Drs in Sweden like in North America, we are witnessing repeated cases. Medical Drs should carefully asses and examine patients profile in order to make right diagnosis as precise as possible. Swedish medical association should look into these cases careful y and discipline appropriately.
10:01 August 7, 2009 by GITM
How long does it take a tumour to get from all but invisible, to fist sized? In this case i would think we are talking about 5 or 6 months....
10:11 August 7, 2009 by Dick Swinger
knowing as much as I do about internal anatomy, I would also add that it is surprisingly common to find fist sized foreign bodies within internal cavities and a the majority of them are nothing to worry about at all.
10:22 August 7, 2009 by Jasoncarter
This is just unfortunate, something that slipped through the net. Happens in all countries and is always newsworthy when it does happen as people love a scare story. However, I wouldn't go moaning about socialised healthcare not being able to afford to treat people properly. I went to my GP having suffered from persistent headaches and he referred me for a brain scan. I received the referral within a week and was scanned within 10 days of my initial appointment. The whole thing cost me 120kr for the visit to the GP and 200kr for the brain scan (and 220kr for a DVD of images of my noggin to take home, but that's not really an essential part of the treatment...). To put that into perspective a 60 minute brain scan cost me the same price as a bottle and a half of Chablis.

This is in Stockholm, where you would expect demand to outweigh provision. I was absolutely amazed by the speed of my treatment, not least of all because I was a non-priority case: the doctor was fairly satisified that there was no underlying problem but sent me for a scan as a precaution.
18:39 August 7, 2009 by Svenska-Flicka
I would have to say this article left a lot out of it, I would be interested to know in the article if she was able to have it removed or if it was too late, here in the US Doctors make a lot of mistakes, that is why all Doctors carry malpractice coverage. Her story is awful but not surprising, but is she gonna live?
06:38 August 8, 2009 by Bender B Rodriquez
If it was fist size it was probably a benign tumour...
06:46 August 8, 2009 by NJGirl
Doctors in US do not carry malpractice insurance because they make a lot of mistakes. Quite frankly they make them rather infrequently. Malpractice insurance is mandatory in order to obtain hospital privilieges for admiting patients to the hospital. This patient hopefully has a benign tumor like menigioma, otherwise she will most likely die thanks to socialized, rationed Swedish medicine.
06:56 August 8, 2009 by Bender B Rodriquez
Bollocks, my family has plenty of experience of Swedish cancer treatment, and I can say that once a tumour is diagnosed the treatment is excellent and extremely swift. The problem is that people go to the doctor too late, why also many tumours are harder to treat. Of course, if we would increase our health care budget to the standard of the US (three times more) we would be able to do a MRI for every headache,...
22:55 August 10, 2009 by davisucr
Brain tumors are rare, 19,000 a year in the US. Most doctors have never seen one. The issue is that a CAT scan was not done as it would have been in the US., because it cost money that the Swedish system does not normally spend. It is probably a GBM and she has a limited time in which to live. It will cost over $200,000 to treat the tumor. Because we live in the US, when my husband had that size tumor, we got surgery, chemo and radiation. After a year, my husband is still ok. My husband's has cost $600,000 and counting; but we have insurance with a stop loss and he is getting the treatment he needs.
08:40 August 11, 2009 by ausboi
Sweden is very open about information. It is possible to easily obtain details about medical mistakes just as private income, addresses etc are all freely available. The culture of litigation in other countries- particularly the US and Australia- acts to cover up these medical errors so they rarely are fully detailed in the media. To be able say sorry in Sweden is a strength of character. In the US & Oz it means you will be sued. In other countries people are given contracts to sign that ensure their story never gets out. Don't think medical mistakes only happen here. They happen everywhere. You just don't hear about them. Believe me, I know, I used to work in the legal department of a hospital.
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