Friday, February 14, 2014

15% of diagnoses are WRONG!!!

"the problem wasn't a bad or ignorant doctor – it was a problem in thinking, only selectively listening to the patient, and in too quickly jumping to conclusion before considering other possibilities.
"... all types of people get unusual diseases. Health care providers need to become aware of their biases so that when someone comes in that might trigger a bias they can consciously move to an analytic mode of thinking."
Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Identifying characteristics of patients mentioned in his column are changed to protect their confidentiality. Reach him at

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As confirmed by Dr. Jerome Groopman, "How Doctors Think", doctors don't LISTEN to patients.  They tune out after just 18 seconds.  If the first symptom you tell them is "I sleep a lot", they don't feel the need to listen any more, because they've already diagnosed depression.  Right or wrong, that's the diagnosis they're going to give you.
One of my quacks was of the opinion that the only thing that could possibly be wrong with a divorced woman was that she was faking so she could get alimony to punish her husband.  My friend and I had both been the primary breadwinner in the marriage and had both permanently waived alimony because our exes couldn't afford to pay it even if it were ordered -- but his bias was a stereotype of divorced women, and he couldn't get past it long enough to listen to facts. 
At the time that we were seeing that doctor, we were unaware that we were going to the same guy, but when we discussed it afterward, he'd said verbatim the same rude things to us, made the same inaccurate assumptions about both of us, chose to hear "I don't want to work" when what we actually said was "I'm trying to work but the symptoms are making it difficult." 
How could he get the same diagnosis from our very different reported symptoms?  Because "depressed divorcee" was a wrong diagnosis.  We don't have the same condition; even a layperson could figure that out in 2 seconds, but this doctor couldn't, because he stopped listening the minute he heard "divorced".  My divorce was final; I couldn't have gone back to ask for alimony even if I'd wanted to.  But why let the law and the facts get in the way of a good prejudice?
And this is one reason why doctors are the third-leading cause of death in the US -- they don't listen.  They extrapolate from a single symptom.  They convince themselves that you have described the other symptoms that go along with what they want to diagnose, even if you have actually provided the symptoms that would lead them straight to a different diagnosis -- they hear what they want to hear, and see what they want to see.  In 1987, my boss took one look at me and said "you look terrible", my friends could see that I was sick, but my doctor wanted to see an emotional basket case and therefore couldn't see that I was deathly pale, weak, barely able to stand up without passing out, confused, running a fever.... all he saw was a psychiatric explanation for why I should be happy that my job was in jeopardy because of my symptoms, "isn't that what you want? To get fired so you don't have to work any more?"  Clearly, he hadn't been paying attention when we told him I was married to a full-time student and my job was the only income we had.  And, clearly, was unaware of how little Disability pays -- it's not enough to support one person, much less two.
If I could tell medical students one thing, it would be to read and internalize Groopman's book.  And if they wanted me to limit myself to one word, that word would be LISTEN!
In law school, we were taught "never assume", but apparently medical students aren't taught that, because they assume too much without asking for verification.  And those assumptions often prove fatal.

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