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?"
Well, you have to add the 30 minutes you sit in the examining room before they walk in.
On tv, they get the diagnosis wrong 90% of the time until about 5 minutes before the show ends.
ping
Yep.
One of my favorite experiences with doctors is the totally blank stare. You tell them some sympton which is extremely important to you, maybe that your left arm fell off that morning. They register absolutely zero reaction and move on. It's not just callousness, it appears to be they dismiss your observation as having absolutely no medical significance and why did you bother them with it. My guess is they are trained to do this to avoid legal liability that might result if they acknowledge the symptom or that they have no idea what causes it.
"Doc, why does it burn when I..."
I've got an 8:15 a.m. Dr's appt tomorrow. Hope he doesn't misdiagnose my stopped up ear due to the bad cold or flu symptoms I have.
The process weeds out smart people in favor of those committed to "service". It weeds out students who had undergraduate records based on intellectual challange in favor of high grades in more rote memory subjects.
We had several students in law school that flunked out during or at the end of the first year who then went to med school and prospered.
There are some good doctors out there. But you sure have to be careful to look around for the right ones.
ping
Actually, it's a lot more than that. It's the fact that we have the capability to treat many more diseases than in years past. There are more choices to make. The amount of learning required has induced increased specialization, which narrows the solution set offered by any one practitioner, often to the point of unapplicability. The amount to learn also decreases the pool of qualified physicians. Doctors want to cure patients, so they try their best within their knowledge. Unfortunately, maladies aren't specialized.
Advanced capability in any specialty often comes at a higher price. That combination increases risk. Pooling risks increases the total that can be spent on any one case, which gradually increases total demand beyond what the payer can bear. The pressure to cut costs increases, as does the risk that the diagnosis is wrong.
Taken together, that means doing more in less time. There are now more "correct" diagnoses requiring more data than can be determined in the time and budget alotted for initial screening.
"P"
re: the 30 minutes you sit in the examining room before they walk in
And the 45 minutes or more sitting in the waiting room before being ushered into an examining room.
Like "What's the phone number of the nearest Chinese herbalist?" ;)
So why is it that when YOU go in for a problem, the doctor sees you for about 15 minutes...but when you take your car in, they keep it all day?
That's why they call it PRACTISING medicine!
Our culture lionizes and exaggerates the power of physicians.They're humans and they make mistakes-a lot of mistakes.
marking
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