Posted on 01/30/2007 10:05:04 AM PST by Caleb1411
Fact: A doctor in this country interrupts a patient, on average, in the first 18 seconds of a visit.
A prominent surgeon waited about a minute and a half before issuing his diagnosis to Jerome Groopman on his damaged hand. "He was dead wrong," says Groopman, who got four diagnoses from six surgeons. "And these are big names."
Fact: More than 15 percent — some say more than 20 percent — of medical diagnoses are wrong. At least half result in serious injury or death.
Groopman tells of a woman who saw close to 30 doctors for a constellation of ailments that gradually sapped the life out of her. She endured excruciating pain and was down to 85 pounds. Her immune system was failing and she had developed severe osteoporosis. All of them missed what was ailing her.
Finally, a fresh doctor asked a fresh set of questions. He listened to her and found that she suffered from a gluten allergy that prevented her from receiving the nutrients in the food she ate. After years of agony, she quickly recovered.
Fact: More than a quarter of all radiological tests, including CAT scans and MRIs, are misread. "Misdiagnoses are not rare at all," says Groopman, the noted oncologist and chief of experimental medicine at the Beth Israel Deaconess Medical Center, who assembled this data.
While the patient safety movement has led to major improvements in protocols to avoid systems errors, he points out, nothing has been done to address a more profound issue: how doctors think. And bad thinking is what causes countless mistakes. "No one talks about this stuff," Groopman says.
He is struck by the lack of independent thinking among the residents he leads on hospital rounds. "These are really smart people, and when asked for a diagnosis they download cookbook recipes on their computers," he explains. "If it's not that, they look blankly. How do I teach them how to think? I realized I didn't know how I think. No one ever taught me how to think."
Groopman addresses this touchy subject in a book, "How Doctors Think," due out this spring. In it are examples of bad thinking, including plenty of his own, that produced harrowing results. None of this is news to patients. Most of us know someone who has endured a misdiagnosis or have done so ourselves. My friend Barbara went through a year of agony because of one.
Groopman's first child developed a persistent low-grade fever and stomach pain at nine months. A doctor said not to worry, it's just a virus. The child's condition deteriorated, but the doctor remained unmoved. Eventually, Groopman and his wife rushed their son to an emergency room, where they learned the child had an intestinal obstruction that would have killed him had it gone untreated.
What went wrong here? The doctor sized up Groopman and his wife as neurotic first-time parents and built his diagnosis around that premise. At work, says Groopman, were two suspects common in these nightmares.
The first is what he calls anchoring — where a doctor interrupts you, seizes on a symptom or complaint, and declares, "It's this." This snap judgment anchors all ensuing thinking. The second he calls attribution, to which women are particularly vulnerable, where assumptions about a patient are attributed to bad data.
Groopman tells of a woman with a newborn child and two young children who complained about constant nausea and diarrhea. "The doctor looked at her and decided it was stress, that she was neurotic," Groopman said. "So he attributes all of her complaints to the stereotype he has in his mind. I saw her a few months ago. She had been diagnosed with a tumor in her intestine but had been taking Zoloft for a year and a half."
Time is an insidious agent in all this. "In today's medical environment, the clinic is a factory," he says. "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.
"It's impossible to figure out a difficult problem in eight minutes," he said. "A doctor has one eye on the clock and one eye on a computer screen as he types notes. The truth is, you can't think well in haste.
"There is no generic best treatment to a serious problem," he says: "We delude ourselves to think the answer is the systems solution — 'We'll give you an algorithm: if it's A then B then C.' You're got to know what A is in the first place."
Many in the medical community will bristle at Groopman's findings. Others will recognize the truth in what he says and, with luck, a few of the bean counters controlling medicine today as well. They can't dismiss the book. It is meticulously researched and written by a physician of stature.
"My argument is the solution for misdiagnosis is a patient or family member who knows how doctors think," Groopman said.
So what should we be asking our doctors, over and over?
"What else could it be?"
This is a problem I am consistently having with my 8 year old daughter. Because we are military, we move from clinic to clinic. My 8yo has complained of severe pain in her stomach almost from the time she could talk. She has very little appetite, and she is way at the end of the growth scale. She isn't having any learning issues, however.
Appointment after appointment has been made, and no one will investigate further than "give her laxatives and make her eat more fiber."
Not one test, not one full exam even. They say she is just constipated, but these pains cause her to double over and she has days when she flat out can't walk from them. But it's all about the laxatives for them.
I haven't found one doctor that will listen to me. And because they refuse to get past the constipation issue, they won't refer her out in town to see a different, non-military doctor. And this has been going on for years.
Whenever a doctor has kept me waiting for more than 15 minutes from the exact time of my appointment, I bill him for my time and deduct it from his fee. When I explain that my time is just as valuable as his, I never get an arguement. All the doctors I use now are trained and have their staff usher me in as soon as I arrive even if others are in the waiting room. If you act like a sheep, expect to be herded!
No matter how educated, or experienced you are - you are still susceptible to errors, oversight, or misinterpretation of problems. It's when ego allows you trust yourself too much and you stop critical questioning that you reduce yourself to doing more harm than good.
Humility is what keeps the ego in check and allows for clear thought no matter what you're engaged in.
I'd be happy just to find a doctor who is fluent in English.
Yes, the "blank stare" is common and irritating. In defense of doctors, though, they have to deal with alot of people who research symptoms on the internet without any sense of background or perspective. The blank stare may be the doctor's way of saying: "I hear you but what you describe is not a concern, despite the fact that a google search might tell you otherwise. I have seen lots of patients and have lots of experience; you have simply done a google search."
Years ago, a doctor did not feel it was necessary to inform me that the polyps he removed from me were stage 4. Took me 3 years to find out. Now, I take charge of my health. I will vigorously question and grill my doctors, dentist, etc. and will not leave or shut up until my questions are answered to my satisfaction. I will tell them to explain to me in laymans terms what they are doing, what the medication is supposed to do, side effects, alternate treatments, etc. If you do not take charge of your own health, no one else will.
Have you kept a note book? When going to the Dr. If at all possible bring a witness to take notes. A spouse, brother, sister who ever.
Have symptoms written out and questions prepared in advance.
And, above all take notes. You will get more attention
if you are writing things down and have a witness.
Sad but true.
Your car does not have a lawyer and does not belong to an HMO.
Differential diagnosis bump!
My son became ill at 8 mos with diarrhea and a swollen belly. By age 11 mos, he had bloody diarrhea and started loosing weight. ("Nothing to alarmed about.") By age 15 mos he'd lost 1/3rd of his body weight and was dying. I put him on a diet of chicken, rice and veggies and he recovered fast. The drs said he had an "immature digestive system" and I was told to keep him on the diet for another year, then wean him onto "normal" foods. I did. By age 7 he started having migraines. By age 9 he began to have symptoms of Autism. We finally got him to a neurologist who discovered that he was a Celiac. After 2 weeks on a gluten-free diet, the headaches returned.
My daughter was much like yours. "My tummy hurts." I swear she was saying this almost every day from the time she could talk. From time-to-time, she'd get a bit bloated, but no diarrhea. A few times she's get constipated, but it wasn't a major problem. About a year and a half ago she started getting headaches. (She's 15 now.) We just discovered that she, too, is a Celiac. After three weeks on the gluten-free diet, she is starting to look and feel better than ever in her life. (and she was screened for the test. It took a more sensitive test to detect the problem.)
In the last month, my aunt, mother and myself have all *finally* been diagnosed. We're all starting to feel better than we have in decades.
If you'd like information on the test, I'll FReep it to you. You can get it yourself without a doctor's order.
Hmmm...I dunno, but you've got to find a way around the buraucracy somehow. If I were you, I'd summarize in writing everything that you've just said, and perhaps have your husband take it to his C.O. I know it can cause problems, but you may have to start mentioning attorneys or news media or something to get their attention. You've GOT to fix the idea in your head that the "status quo" is not going to be tolerated anymore and act on it. Your daughter is a civilian, and if the military can't get the job done for her, somebody else will have to.
I can tell you from recent experience from having my mother in the hospital for about 2 months (car crash), the squeaky wheel gets the grease. She would probably have died (a couple of times) if it wasn't for my brother and I "rattling cages" and "stepping on toes". Do whatever it takes.
Thanks for the ping. Assumptions about docs, a rather varied lot, are always amusing to me.
And when you find a good one, never let go until they are in the grave or you are in the grave, one or the other.
Have you investigated food allergies on your own? I would check out wheat (gluten) and dairy if one of my children had those sorts of symptoms.
If neither of those seemed to be the problem, I would keep looking at intestinal difficulties, including Crohn's Disease. Growth issues and intestinal distress are both connected with that.
If you walk in with your notebook as suggested above, and can say, "We stopped this or that food for a week and it seemed to help," you can help the Doctor start down a more useful path.
Google, Ask.com, and Webmd can be your friends. I'm of the opinion that as a mom, I am the primary caregiver for our family. Our doctor(s) are consultants that I use. :-) YMMV
And what the searches produce! Other than Medline, etc., a Google search of some medical topic produces valid, peer-reviewed literature, the ravings of fringe medicine advocates, and endless ads for herbal supplements, fake "Viagra", quack remedies, Canadian prescription outlets, and the usual Searchbot, "Buy your _Pneumonia Symptoms_ on EBay!" garbage.
Yes, in some cases, the Blank Stare may mean, "I am an idiot and am dumbstruck".
But usually it means "I am tired of listening to idiots", or "Not this again".
A doctor's need to be right is almost as important as his need to be rich.
Sometimes I think we're pretty close today with the prevalent PCP (primary care physician) acting as gatekeeper to anyone else with many insurance company and HMO plans. If he doesn't listen, you've either got to get another PCP, or go "out of network" at significant expense and delay.
Good article. There is a lot of this incompetence in general medicine. Plus apathy toward patients.
Unless I'm mistaken, most of my post was not "assumptions about docs," but more about the environment in which they operate.
You couldn't be more correct! It's all about information overload and the rest of the stuff you described so well!!!
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.