Publicity still of actress Patty Duke in 1962.
Even highly trained doctors can miss the signs of some common but serious conditions, especially when they present with nonspecific symptoms that could be almost anything.
So although laypeople should not be expected to second-guess medical professionals when they seek advice, it does not hurt to keep some common possibilities in mind. But don’t take my word for it: Ask Dr. Judy Stone, an infectious disease specialist who regularly writes for Forbes. (Disclosure: Stone is also my wife’s cousin.)
In a recent Forbes column, Stone used the death of actress Patty Duke to draw attention to the dangers of sepsis. Sepsis, an overwhelming inflammatory response to infection, caused Duke’s death at the age of 69, according to a statement from her agency. It also affects over 1 million Americans a year. Sepsis can cause severe organ damage and, in 40 to 50 percent of severe cases, death; it ranks eleventh as a cause of death in the U.S. overall. Yet many Americans remain unaware of the condition, according to a survey commissioned by the Sepsis Alliance last year.
We do not know the details of Duke’s case, or whether earlier or stronger intervention could have made a difference for her. We do know, however, that studies have shown earlier intervention and treatment can significantly reduce the overall number of people who die of sepsis. Aggressive antibiotic treatment within the first hour of low blood pressure – called the “golden hour” – is associated with an 80 percent survival rate. The longer treatment is delayed, the further that rate drops.
The effectiveness of treatment and the fact that time is a critical factor in survival mean that the patients most likely to survive sepsis or septic shock are those whose condition is identified soonest. Unfortunately, the symptoms can be frustratingly nonspecific, such as fever, shortness of breath and nonlocalized but acute pain. They may also include gastrointestinal distress, making it easy to confuse with a severe case of flu in some instances.
“There is no single test for sepsis,” explained Dr. Scott Weingart, the director of critical care at Elmhurst Hospital Center in New York. “It requires careful screening of patients who might have it in order to identify the ones who actually do. It’s like looking for a needle in a haystack.”
Because of the difficulty of diagnosis and the potentially lethal consequences of missing early warning signs, many hospitals adopt protocols designed to catch a potential septic reaction early. In 2013, New York Gov. Andrew Cuomo announced that the state would be the first to require all hospitals to institute best practices for the early identification of sepsis. He estimated the more rigorous requirements would save 5,000 to 8,000 lives annually.
This initiative, along with regulations requiring clear and direct communication to parents of pediatric hospital patients, was named for Rory Staunton, a 12-year-old who died due to an initially misidentified case of sepsis in 2012. His parents also established a foundation aimed at improved diagnostic techniques and effective treatment, especially of sepsis in children.
I have never had to deal with a sepsis condition personally. I have, however, had similar experience several times with elderly relatives. They became confused, irritable or unusually aggressive – and not gradually, as you would to see with dementia, but more or less overnight. My relatives were not able to articulate what was wrong, but something was clearly amiss.
It was not doctors who thought to check for urinary tract infections. It was home health aides and, in one case, ambulance paramedics, who frequently come in contact with older adults and who recognized these symptoms. Sure enough, my relatives were back to their old selves almost as soon as they began an antibiotic treatment to clear the infection.
While the very sick, the very young and the very old are most prone to sepsis, it can affect anyone. In her column, Stone explained that the Centers for Disease Control and Prevention urges patients, or loved ones accompanying them to the hospital, to say directly that they are worried about sepsis in cases where symptoms seem to match up to the condition. Alerting a health care professional, even if you cannot be sure of a diagnosis, can at least serve as a reminder in the often hectic atmosphere of an emergency room or intensive care unit.
We do not want to be our own doctors, but an informed and questioning patient or advocate can still be a big help and, in some situations, a lifesaver.