In January 2001, a young tech founder came home to California from a trip that included a safari in South Africa. He felt dizzy. He had chills that kept coming back. He vomited in an emergency room.

Doctors treated him for viral meningitis. He kept getting worse, until his pulse was barely detectable.

Then an infectious-disease specialist happened to walk past his bed and recognized what the others had missed: falciparum malaria, the most dangerous form of the disease.

The patient was Elon Musk. He spent 10 days in intensive care and about five months recovering. Years later he joked that the lesson was “vacations will kill you.”

The real lesson is less funny. The clue was there all along. He had just been somewhere malaria is common. But the first diagnosis fit well enough, and nobody stopped to ask what else it could be.

If it can happen to one of the most famous people alive, with access to the best care money can buy, it can happen to you, your parents or your kids.

This is not rare

We tend to think of misdiagnosis as a freak event. The research says otherwise.

• About 1 in 20 U.S. adults seen in outpatient care experiences a diagnostic error each year. That’s roughly 12 million people, and researchers estimate about half of those errors could cause harm.
• About 795,000 Americans die or are permanently disabled each year because a serious illness was missed or misdiagnosed, according to a 2023 national estimate.
• Most of us will experience at least one diagnostic error in our lifetime, according to the National Academies of Sciences, Engineering, and Medicine.

The biggest share of serious harm doesn’t come from rare, exotic diseases. It comes from common ones, such as strokes, infections and cancers, that look like something milder at first.

Why good doctors miss things

Missed diagnoses are rarely about bad doctors. They’re about how every human brain works, under pressure most patients never see.

Doctors think at two speeds. Fast thinking is pattern recognition: instant, and usually right. It’s how experts work. Slow thinking is deliberate: it questions itself and takes effort. Errors happen when fast thinking should have handed off to slow, and didn’t.

That happens through a handful of predictable traps:

• Anchoring. The first explanation sticks, even when new symptoms don’t fit it.
• Premature closure. A diagnosis that fits well enough ends the search before other causes are ruled out. It’s a common pattern in stories like Musk’s.
• Availability bias. What’s on a doctor’s mind, like the three flu cases they saw that morning, feels more likely than it is.
• Confirmation bias. We notice what supports our idea and explain away what doesn’t.
• Diagnosis momentum. “Possible migraine” in one note becomes “known migraine” in the next, until no one re-checks it.
• Diagnostic overshadowing. If you already carry a label like anxiety, new physical symptoms get blamed on it.

Add short visits, missing records and exhausted clinicians, and those shortcuts get leaned on harder. None of this means your doctor doesn’t care. It means the system makes thinking twice difficult, so sometimes you need to prompt it.

What you can do at your next visit

You don’t need medical training to help your doctor think twice. You need a few sentences.

Before you go, write down your top three concerns and lead with the most important one. Visits are short, and the first thing you say shapes everything after it.

Tell them the context, even if it seems unrelated: recent travel, new medications, a family history, a change in your normal. Musk’s missing clue was where he’d been.

Before you leave the room, ask:

1. What else could this be?
2. What’s the worst thing it could be, and how did we rule it out?
3. Is there anything that doesn’t fit?
4. What should make me come back sooner?
5. When will my results come back, and who calls me if they’re abnormal?

If you’re not getting better, say so plainly. “This is not my normal.” “I’m not improving. What else could this be?” Being clear isn’t being rude.

Good doctors welcome these questions. They’re trained to ask them of themselves. You’re just helping them do it.

One question

Every one of those traps has the same way out: “What else could this be?”

Doctors are trained to ask it. You’re allowed to ask it too.

We made a series of 10 short films, each under a minute, that walk through these traps with real-world examples and the question that helps with each one. You can watch them all, and get the free MayaMD app to organize your symptoms before your next visit, at mayamd.ai/whatelse.

And if it took more than one doctor to get your diagnosis right, we’d like to hear what finally made someone look again. Share your story on the same page. We’ll always ask your permission before sharing it.

This article is for general education, not medical advice. If you think you’re having an emergency, call 911.

Also published on Substack. #WhatElse

Sources

• Walter Isaacson, Elon Musk (2023), as reported in “Elon Musk once caught malaria on safari and was ‘hours from death,’ book says”, Business Insider via Yahoo, Sept. 13, 2023.
• Singh H, Meyer AND, Thomas EJ. “The frequency of diagnostic errors in outpatient care.” BMJ Quality & Safety, 2014.
• Newman-Toker DE et al. “Burden of serious harms from diagnostic error in the USA.” BMJ Quality & Safety, 2023 (Johns Hopkins summary).
• National Academies of Sciences, Engineering, and Medicine. Improving Diagnosis in Health Care, 2015.