Why do doctors miss diagnoses, even when the patient is a doctor?

Dr. Steven Charlap lost his brother, a cardiologist, to a misdiagnosis. He says it comes down to time, incentives and how many diseases one doctor can know.

Doctors miss diagnoses because they are people working under a clock. According to Dr. Steven Charlap, a primary care visit gives the doctor fifteen or twenty minutes to land on the most common explanation, and a doctor sees only a small share of the diseases that exist over a whole career. His rule for patients is three words long: trust but verify.

Steven knows this from the worst possible seat. His older brother was a cardiologist, the one Steven followed into medicine, and a misdiagnosis killed him. A physician inside the system, with every advantage a patient could have, and it still missed. Steven is a surgeon trained at NYU with an MBA from Harvard. He spent twenty-one years co-founding and running HealthDrive, a mobile medical company, and for the last decade he's been building Medome. I had him on the show because I wanted to understand what he learned from that loss, and why he thinks it keeps happening.

How much time does a doctor actually have to find the right answer?

Less than you'd hope. Steven was careful to say he doesn't think doctors miss things on purpose. His point is about the system they work in. Doctors are under pressure to move fast with every patient, and medical school trains them to reach for the likely answer first. He quoted the line every student hears: when you hear hoofbeats, think horses, not zebras.

So the doctor goes for the most common explanation inside the fifteen or twenty minutes allotted to you. If it's wrong, you come back and they try again. Steven added something I hadn't thought about. In his view, the doctor has no financial incentive to prevent disease, catch it early or get the diagnosis right on the first visit. He called it arguably a disincentive.

How many diseases can one doctor realistically recognize?

This was the part of the conversation that stopped me. Steven's numbers: over thirty years, a primary care doctor might see about a thousand diseases. There are roughly 28,000. More than 11,000 of those are rare diseases. Most of a doctor's day, he said, goes to a few dozen to a few hundred conditions they see over and over.

Do that math and the problem is obvious. A common disease that shows up in an unusual way, an uncommon disease or a rare one is very hard for a single human to catch. That's no insult to the doctor. There's only so much one person can carry.

So putting your full faith and trust in a human being, even if they are a trained doctor, is simply a mistake in 2026, which is why I always say trust but verify.

Dr. Steven Charlap, 04:58

He gave more figures later in the episode. By his account, primary care doctors miss the right diagnosis 30% of the time, and 21% of referrals to specialists are inappropriate. That means a patient can wait weeks for a specialist and then learn they were sent to the wrong one. He also pointed out that the two leading causes of death in the United States, heart disease and cancer, are also the two most commonly misdiagnosed conditions.

What happens when a patient takes three medications at once?

Steven's own story answers this one. He explained that the tools doctors use mostly check whether two drugs clash. Once a third drug enters the picture, he said, there's almost nothing, and plenty of people take four, five or ten. So his team built a checker for combinations of three drugs or supplements. He says it holds over 2,200 combinations that shouldn't go together.

Steven was on one of them. He'd asked his doctors about two of his drugs without realizing the third one mattered. Three doctors told him to stay on the drug. One said he could probably stop. Three AI models said stop. He stayed on it. When his own checker flagged that the third drug made the other two worse, he stopped the second drug that day. Then he went back to his doctors. One said he knew about the interaction and couldn't explain why he hadn't mentioned it. The other, a cardiologist, didn't know about it at all.

Steven's view is that his own product may well have saved him from a terrible outcome. Steven noted that most doctors never collect your supplements at all. So if you take several medications or supplements, his story is a reason to bring the full list to every appointment and ask your doctor how they work together as a set.

Does a better doctor miss less?

Better doctors worry more. Steven described his brother as an unbelievable doctor whose patients loved him, and when I asked what made him so good, the answer surprised me.

He was paranoid that he was missing something.

Dr. Steven Charlap, 29:57

That fear kept asking the right question: what am I missing? Steven's point is that even a doctor who asks it constantly is still one person with one memory. His brother was a father of four. He met two of his grandchildren and missed the other sixteen. Steven also lost his wife's best friend, a doctor, to a misdiagnosis, and says he was misdiagnosed himself and nearly died in Japan after a cruise.

What does trust but verify look like for a patient?

It means you keep your doctor and you check the work. Steven designed his diagnostic databases to ask a backwards question. Most tools ask which diagnosis is most likely. His asks which diagnosis you're most likely to miss, and what else you should ask so you don't miss it. He compared it to a Wall Street Journal story about ChatGPT solving a decades-old Erdős math problem, where the answer came from an approach nobody expected.

He also mentioned that the Mayo Clinic, with every specialist under one roof, still sends about 20% of patients home without a diagnosis, by his figure. And he told us about a new study with a hematologist who sent three hard cases, one of them described as nearly impossible. His system got all three, and the doctor sent seventeen more.

For a patient, verifying can be plain and unglamorous. Keep your own records. Write down every medication and supplement. Ask your doctor what else it could be and what would rule it out. If something still doesn't add up, get a second opinion. None of that replaces your physician. It makes the visit harder to get wrong. This post shares Steven's experience and views from our conversation, and it isn't medical advice. Take any health question to a qualified clinician.

Why does one founder pour his own money into this?

Steven says he takes no compensation from Medome, has put in over four million dollars and more than 30,000 hours of his own time, and has given his stock to his kids. He estimates that someone in the United States dies from a misdiagnosis every 1.4 minutes, and that misdiagnosis costs the country a trillion dollars a year. He built this in memory of his brother. What I heard was a founder who took the thing that broke his heart and turned it into a system, so the next family doesn't have to learn trust but verify the way his did.

Cut from His Brother Was a Cardiologist. He Still Died From a Misdiagnosis.