Tuesday, November 25, 2014

How Do I Make a Medical Decision? Part II

When last I wrote about making a medical decision (Part I), I focused on the importance of identifying a trusted source to assist you in the process.  While there are inanimate sources such as Internet sites of more or less trustworthiness, printed or pixelated matter informants are one-way interactions.  You  match your situation with the closest approximation available which cannot in turn adjust its wisdom to the unique details of your past or present history.

So let's say your matter involves a consultation with a medical professional.  You've doubtless arrived with thoughts on your subject. What's going through your doc's mind as you meet face-to-face?  

From the first moment that I greet a patient, I am already forming hypotheses or educated guesses. Back in the good old days, I'd walk to the waiting room to call a patient in; we'd shake hands in greeting ( fingers dry? cold? clammy? weak?)(1), then I'd watch them walk--or limp--down the hall.   Armed with the 'reason for visit' from my day's schedule, I'm looking for pattern recognition from moment one of our visit, and 33 years into practice, I've seen a lot of patterns go by(2).  In for foot pain?  Teenaged boy limping with skateboard in hand maybe has broken his toe; older, stout man in a suit, well perhaps he's got gout.

My thoughts are forming as I call on experience (Have I seen this before?) and/or evidence (Have I read about this before?).  If I jump to a conclusion too fast, a diagnostic error called 'premature closure', I'm risking a missed diagnosis which could be inconsequential or a downright disaster.  If I narrow the diagnostic field not at all (which, unfortunately, seems to be an ER predisposition), I may be heading for an unguided work-up of unbridled costs in money and time.  What if I don't let go of my initial impression as contradictory test results come in--an 'anchoring bias'--or fall into a 'confirmation bias' in which I highlight data that supports my anchored diagnosis, ignoring the results that just don't fit in. 

No wonder patients prefer doctors with whom they have a history, seek information on the Internet, and request second opinions.  Now more than ever, get informed and ask questions. Be an advocate for yourself and your family; you're half of the diagnostic partnership.
(1) There's a serious debate now over whether or not patients and docs should shake hands.

(2) Which raises an interesting question:  Would you rather be seen by a doc out in practice for years with a lot of hands-on experience or one just out of training who's up to date on the latest medical studies, clinical tests, and procedures?

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