Misdiagnoses and broken bones: More on Duke Student Health's mishaps

Student Health could have prevented it.

But they didn’t.

Two years ago, junior Joe Nagy visited Student Health for symptoms including sore throat, fever, congestion, swollen glands and a hoarse voice. The nurse practitioner performed a rapid strep test and swabbed the back of his throat for culturing. She prescribed Nagy with antibiotics after a positive quick strep result, though two days later the throat culture indicated that it was a false positive.

After Nagy finished the course of antibiotics, his symptoms stopped for a day—only to return significantly worse than before. His severely sore throat now gave him pain while swallowing.

Twelve days after his first appointment, he returned to Student Health, where the same nurse practitioner performed another rapid strep test and checked for mononucleosis. Results showed that Nagy had neither, so she diagnosed him with laryngitis—an inflammation of the voice box that usually resolves on its own—and simply suggested Tylenol for pain.

The next morning, he struggled to breathe.

“I opened my eyes and I felt like my throat was closing up. It was terrifying,” he said.

Nagy called Student Health, and the nurse’s response surprised him.

“He said that if I came in later or didn’t wake up as early as I did that day, I probably would’ve died,” he said.

Beyond the near-death experience, Student Health’s misdiagnosis and nonchalant attitude toward Nagy’s two weeks of symptoms bore academic consequences.

He missed all of his midterms and needed a two-week extension on schoolwork for recovery, which led to the stress of catching up for the rest of his first semester at Duke.

Nagy and his family have lost all confidence in Student Health.

“My mom told me to never, ever, ever go back to Student Health, so when I get sick now I just go to urgent care,” Nagy said.

Student Health’s carelessness also caused a Duke senior to suffer far longer than necessary. She asked that I only disclose her year for this story because she is employed by Duke Health and feared retaliation at work.

She visited Student Health during her freshman year for symptoms including painful cough, large amounts of mucus, fever, difficulty breathing, body aches and fatigue. The nurse practitioner diagnosed her with allergies and suggested over-the-counter allergy medication and nasal spray.

Two weeks later, her symptoms had worsened to the point where she frequently needed to step out during class due to uncontrollable cough or shortness of breath. The coughing also prevented her from sleeping through the night, affecting her mental health and ability to concentrate during the day.

She made another appointment with Student Health, but asked to meet with another provider.

Nonetheless, her request was ignored and the same nurse practitioner merely repeated her diagnosis from the last appointment and told her to continue using the nasal spray.

For the next month and a half, she followed the instructions given and hoped that the allergies would improve over time, but relief never came. She revisited Student Health for the third time, when a different nurse practitioner prescribed her with an antibiotic called azithromycin and prednisone, a steroid that treats inflammation, to treat her “dry cough.” 

Four days later, she finished the medications as prescribed with no signs of improvement. She wanted to see a doctor off campus, but she was overwhelmed by final exams and had no experience seeking out her own medical care. So she made another appointment with Student Health.

This time she also felt newfound tenderness in her left rib cage.

The nurse practitioner from her first two appointments returned to the case and diagnosed her with costochondritis, an inflammation of the cartilage in the ribcage. She simply told her to take cough syrup and Advil for pain.

Two days later, she felt a sharp pain where she previously felt the tenderness. She lifted up her shirt and saw a bruise “bigger than the size of [her] fist” on her left rib cage.

She returned home the next day for winter break and immediately saw a pediatrician. Through an x-ray, the doctor found that she had chronic bronchitis that went untreated for so long that the coughing fractured one of her ribs.  

“It was very scary,” she said. “The Student Health system at Duke is really disappointing given the caliber of university we go to.”

The two students shared medical records confirming the events at Student Health. 

John Vaughn, director of Student Health Services, said that he legally cannot speak on specific cases, but declined to comment any further. 

In 2015, the Institute of Medicine, the health arm of the National Academy of Sciences, reported that 12 million adults are misdiagnosed annually. It also states that “insufficient attention” has been given to diagnostic errors, a critical area that lacks data and reliable measures.   

Diagnostic errors account for “approximately 10 percent of patient deaths” and “6 to 7 percent of adverse events in hospitals,” according to previous research cited in the report. 

Patient misdiagnosis occur nationally, but reported experiences, and the dismissive attitude often cited by students, suggest that Duke Student Health is not doing enough to minimize this known and potentially lethal problem. 

Both Nagy and the senior followed up with Student Health multiple times, giving them plenty of opportunity to catch their mistakes and examine the students more diligently or through alternative methods. Instead, nurse practitioners tossed patients with tests for two of the most common illnesses among college students or parroted the same suggestions for over-the-counter medication, regardless of the sensitivity or frequency of the student’s visits. The lack of doctor involvement in either student’s case is equally troubling. 

The assumption that young people are healthy and not prone to illness is not an excuse to neglect taking their healthcare seriously. In making this excuse, Student Health puts us all at unnecessary risk.

Most businesses retain customers because their product or service is worthwhile. Student Health retains patients because most students cannot conveniently leave campus, do not have the experience or financial means to find outside doctors and recognize that they have already paid the mandatory Student Health fee of at least $400 per semester.

Student Health has fomented a black-box monopoly wherein dangerous misdiagnoses go unchecked, leaving unknowing students to fend for themselves. It’s time they own up to these institutional failures and start delivering the reliable, thorough care students deserve. 

Rose Wong is a Trinity senior and a Local/National News Editor. 

Editor’s note: This column is part of a new recurring series on health at Duke called “vital signs.” If you have experienced a misdiagnosis at Student Health, contact Rose Wong at rosanna.wong@duke.edu.