How doctors think - Intro
I recently had the pleasure of a first appointment with a specialist about some health issues I've been dealing with. As part of his history taking, he asked me questions about general health and surgeries (pretty standard stuff). The difference was he really listened to what I was saying from a problem solving (not a recording perspective) and came up with a diagnosis for a chronic health problem that had never been suggested before even though I had told 7 doctors in the last 10 years about my concerns. He then gave me material to read about his diagnosis and I went and did some research on my own that supported what he had told me.
Contrast this experience with one I had in my early twenties where I went to my doctor with severe stomach cramps. The physician introduced me to the young doctor he was teaching as another woman with mysterious stomach pain. Beyond my frustration at being typecast in that manner, I knew what was wrong but was not being listened to. A week later, I had emergency surgery for the very issue I had tried to explain. This doctor failed me as a patient but he also failed as a role model for his student.
I was of course personally interested in the specialist's ability to diagnose, but I was also professionally interested in how we teach differential diagnosis. I recently ordered a book called "How doctors think" http://www.amazon.ca/Doctors-Think-Jerome-Groopman-M-D/dp/0618610030. Dr. Groopman believes that some preventable medical errors are a direct result of not listening to the patient because we place them into categories such as women with mysterious abdominal pain (attribution errors) or rely on diagnoses from previous medical professionals that may have been incomplete.
I plan on doing a series of posts from this book when it arrives.
Comments
While it is really important to listen to one's patients, it is also important to realize that the knowledge base and experience is needed to apply the information the patient gives to diagnose. The last doctor that you saw, was able to link the normal function of the body, the pathophysiology behind the symptoms to give you the right advice. It is interesting to see that the treatment of your problem was a negotiation between you as a patient and himself/herself. He/she gave you the information to see for yourself how your symptoms relate to the bodily function. This certainly will increase your compliance as a patient wont it?
Posted by: Kalyani Premkumar | April 9, 2007 08:50 AM
Thank you for the reminder Dr. Premkumar. Differential diagnosis is indeed a complex process that involves honing several skills and continually updating your knowledge base.
You are also correct that involving the patient in their care is more likely to result in compliance.
Posted by: Deirdre Bonnycastle | April 9, 2007 09:51 AM
It seems like many doctors attempt to interview a patient simultaneously with the physical exam. I'm not sure multi-tasking that way is a good idea, as you may focus so much on what you're seeing and palpating, you can miss something important the patient says.
I've started doing a self case write up with any presenting problems, comorbid conditions, current vs. normal Rx, etc. before seeing a physician. It really seems to help the doc to have the written summary and it saves time when I can just hand it to her for the chart.
Perhaps there needs to be a bit of patient training during K-12 on how to help your doc help you.
Posted by: BJ | April 19, 2007 09:48 AM
What a good idea! Thank you for sharing.
Posted by: Deirdre Bonnycastle | April 19, 2007 09:51 AM