Doctors See the Expected, Revisited

Diagnostic issues are the leading cause of medical errors. That’s well known. For example, when doctors see a patient who is having trouble breathing, the first thought is probably pneumonia. The second thought might be COVID-19. What they probably don’t consider is tuberculosis.

And that’s a problem. Tuberculosis exists in the US although doctors only see it on rare occasions. Globally, TB is a leading cause of death.

The World Health Organization standard is that a person with an active case of TB, meaning they have symptoms and are contagious, needs to be diagnosed and treated within two to three weeks of their initial visit to a doctor.

According to researchers at Harvard Medical School, the US isn’t meeting the WHO standard. Delays in diagnosis typically run from 10 to 45 days, although in extreme cases, have been as long as 250 days, based on a study of insurance records. Doctors fail to order inexpensive diagnostic tests because they aren’t considering TB as a possibility. The delay allows the infected individual to pass the disease to other family members, and puts the patient at risk of complications and a worse outcome.

Older patients and those with compromised immune systems are most at risk of delayed diagnosis.

Like COVID-19, there are people who carry the virus without showing symptoms. However, these people aren’t considered contagious until symptoms actually develop.

As a patient, about all you can do is to encourage your doctor to be exhaustive in testing. The insurance companies may not like it, but it’s your life.


  1. Matthias I Gröschel, Maha R Farhat. A legacy of disease. The Lancet Infectious Diseases, 2021; DOI: 10.1016/S1473-3099(21)00165-1
  2. Harvard Medical School. “Study identifies concerning delays in TB diagnoses in the United States.” ScienceDaily. ScienceDaily, 22 March 2021.


  1. Thank you, Vic, for this important reminder.

    I also wonder if TB is seen as a poor-people’s disease, nowadays, since it has mostly been eradicated, but one still has to get a TB test to work in the school system, at least in most state, and in the District of C.



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