Accept This Truism — It May Save Your Life
When you visit a primary care doctor (or specialist) for a specific problem or symptom that has been troubling you, one of the most important questions you can ask your doctor, after he or she gives you a diagnosis is, “What else could this be?” Jerome Groopman, M.D., in this book How Doctors Think includes this in a list of five questions titled, “Questions to Make Your Doctor Think.” This book is one of the most important publications for the lay person that anyone interested in their own health should own.
The reason Groopman includes these questions is a study that found many doctors make up their minds about a diagnosis in the first four minutes of a consultation and then, following a flow-chart approach, where each step is based on a yes or no answer to the preceding step, proceed to a solution, never realizing they may have gone off track early on in the interview. Here are the rest of Groopman’s questions:
- Tell the doctor your story afresh—as if he/she had never heard it before.
- What is the worst case scenario for the symptoms?
- Is there anything about your diagnosis that doesn’t fit the symptom(s)?
- Is it possible that I have more than one problem?
There’s no doubt that this process may add a little time to the interview, but if your doctor objects or starts looking at the clock, you might want to consider another doctor.
The importance of the above is strengthened by a recent study at the Johns Hopkins University School of Medicine in Baltimore. Dr. David Newman-Toker at Johns Hopkins wrote a commentary on the study, telling Reuters Health that, “”We have every reason to believe that diagnostic errors are a major, major public health problem.” “You’re really talking about at least 150,000 people per year, deaths or disabilities that are resulting from this problem.”
The study was based on electronic health care records tracking 190 errors in diagnosis made during primary care visits at one of two healthcare locations. “In each of those cases, the misdiagnosed patient was hospitalized or turned up back at the office or emergency room within two weeks.” Nineteen percent of the errors caused permanent damage and 14 percent died. The kinds of inaccurate diagnoses varied, including “Pneumonia, heart failure, kidney failure and cancer each accounted for between five and seven percent of conditions doctors initially diagnosed as something else.” The full study is “Types and Origins of Diagnostic Errors in Primary Care Settings,” found online in JAMA Internal Medicine. A similar study in the same publication, “Diagnostic Error in Medicine: Analysis of 583 Physician-Reported Errors,” covered “669 cases were reported by 310 clinicians from 22 institutions. After cases without diagnostic errors or lacking sufficient details were excluded, 583 remained. Of these, 162 errors (28%) were rated as major, 241 (41%) as moderate, and 180 (31%) as minor or insignificant.”
The leader of the study, Dr. Hardeep Singh from the Houston VA Health Services Research and Development Center of Excellence, said most of the problems occured because of fairly common complaints like mild breath shortage and a bit of a cough. The primary care doctor might diagnose bronchitis, but two days later the patient could be back with heart failure. Singh stressed the importance of patients coming to the doctor with “all of the relevant information about the nature and timing of their symptoms.” Newman-Toker added, “”I do think it’s important for a patient to question or observe the doctor. Ask pointed questions: ‘What else could this be? What things are you most concerned about?'” In additional Newman-Toker told Reuters Health that patients should “not just assume that once the diagnosis has happened the first time, that everything is said and done and that it’s all over. You just can’t have blind obedience to the doctor’s diagnosis.”
Take this information to heart and believe in the slogan of this blog,” Your Health Is Too Important to Leave Solely to the Medical Establishment.”