Doctor, what Else could it Be??
On the way in today, I heard an NPR piece with Jerome Groopman the author of How Doctor’s Think. You can listen to it Here but in the meantime here are a few points to keep in mind the next time you (or your kids) visit the Doctor:
- A doctor in this country interrupts a patient, on average, in the first 18 seconds of a visit.
- Misdiagnosis occur in about fifteen per cent of cases, and many misdiagnoses are the result of readily identifiable—and often preventable—errors in thinking. At least half result in serious injury or death.
- Research shows that most physicians already have in mind two or three possible diagnoses within minutes of meeting a patient, and that they tend to develop their hunches from very incomplete information (this is called anchoring -- where a doctor interrupts you, seizes on a symptom or complaint, and declares, "It's this." This snap judgment anchors all ensuing thinking). This leads to “representativeness” errors and Doctors make such errors when their thinking is overly influenced by what is typically true; they fail to consider possibilities that contradict their mental templates of a disease, and thus attribute symptoms to the wrong cause.
- Doctors typically begin to diagnose patients the moment they meet them. Even before they conduct an examination, they are interpreting a patient’s appearance: his complexion, the tilt of his head, the movements of his eyes and mouth, they way he sits or stands up, the sound of his breathing. Doctors’ theories about what is wrong continue to evolve as they listen to the patient’s heart, or press on his liver. To make diagnoses, most doctors rely on shortcuts and rules of thumb—known in psychology as “heuristics.”
- Doctors can also make mistakes when their judgments about a patient are unconsciously influenced by the symptoms and illnesses of patients they have just seen. Many common infections tend to occur in epidemics, afflicting large numbers of people in a single community at the same time; after a doctor sees six patients with, say, the flu, it is common to assume that the seventh patient who complains of similar symptoms is suffering from the same disease.
- Representativeness and availability errors are intellectual mistakes, but the errors that doctors make because of their feelings for a patient can be just as significant. We all want to believe that our physician likes us and is moved by our plight. Doctors, in turn, are encouraged to develop positive feelings for their patients; caring is generally held to be the cornerstone of humanistic medicine. Sometimes, however, a doctor’s impulse to protect a patient he likes or admires can adversely affect his judgment.
- Time is an insidious agent in all this. "In today's medical environment, the clinic is a factory," says Groopman. "It's a world of eight-minute visits. The mistakes are made in the moment. Doctors draw immediate diagnoses rather than listen and pursue leads. And when complaints persist, they all too often cling to their first thought and even discount contradictory evidence.”
So what should we be asking our doctors, over and over?
"What else could it be?"
Comments
Thankfully my mother would go in and make her own diagnoses, but on busy days the nurses would become a huge crutch. Always, always, always write down all of your symptoms and go over every single one with the doctor, even if they seem unrelated!
this may be true of some doctors but by me working on the medicine side of things some patients are just down right rude. My hats off to doctors, nurses, pharmacists and pharmacy techs.
Another note: there is a move to have physicians begin filling new prescription via computer or pc tablet because their handwriting is so terrible. I hope this comes about more pharmacist are complaining that they can not read the doctors handwriting. (HIP HIP...HORAY!!!)
As always Ms. G...great information...this is going in my favorites. ^_^
Always, always, always write down all of your symptoms and go over every single one with the doctor, even if they seem unrelated!
I Think that is CRUCIAL!!! Write down everything that concerns you before you go...because in the Office, you feel the time-pressure and will usually forget Something or get sidetracked by the Doctor's train of thought
In the legal venue it is known as profiling. In the computer programming field, it's what seperates a fast experienced guru from a newbie. We expect police officers, soldiers, fire fighters, and, yes, doctors, to be able to respond in critical life and death situations with quick accurate judgements. If a patient goes into anaphylactic shock and their airway swells and becomes obstructed, we expect the doctor to inject norepinephrine, intubate, perform a trach/crych; whatever is necessary. Medical training trains a doctor to perform in such situations (usually after 24 hours with little sleep) so that doctors can perform no matter the situation. Unfortunately, doctors may then continue to use the same rapid decision making in a normal clinical setting (so that they can see more patients and make more money or pay off their loans or pay back the office expenses).
That's what seperates a merely competent doctor from a good doctor: the ability to use time and information gathering as techniques to supplement the heuristics. Good doctors know their biases and use methods and models to guard against snap-judgements.
Always a first interpretation is made; we all do that as a survival mechanism. When you're out late at night the first glance you have of a stranger is used to interpet their clothes, their hair, the look in their eyed: Is he a threat, or is it safe? After we know it's safe, then we gather further information. Sometimes we realize that quick judgements were wrong. He isn't reaching for a gun in his coat pocket but rather his keys. Likewise the good doctor continues to gather information as he examines the patient, and questions those possible diagnoses.
If you meet a doctor that interrupts you, rushes to judgement, who doesn't keep questioning his/her diagnoses then you haven't met a good doctor. Look elsewhere.