By Evan Falchuk
Do doctors really listen to their patients? A provocative new book, When Doctors Don’t Listen, says it’s all too easy for doctors to rush through the decision-making process – causing misdiagnosis and needless suffering.
It doesn’t have to be this way.
One of the best doctor-bloggers out there, Davis Liu, observed that while patients have to be engaged in the process of helping get the right diagnosis, it is doctors
who will need to take responsibility of getting the right patient history, have the ability to decide when someone does and does not fit the clinical protocol, and when the medical culture hierarchy is too stifling and too rigid to allow dissention (like a resident physician questioning an attending, a nurse to doctor about the right course of action) to allow the better decision to surface, that will also make the difference.
This isn’t easy, but too many of the policy decisions in recent decades have made this process harder – and we’re starting to see the results. Today, one in four patients misdiagnosed, and research shows the biggest driver of misdiagnosis are mistakes in thinking to which doctors, like the rest of us, are very susceptible.
Researchers call them “cognitive biases,” a well-defined set of ways the human mind plays tricks on you. They’re worse when you make a person decide something fast. As in: quick, what weighs more, a pound of feathers, or a pound of rocks? An easy question, sure, but it’s also easy to get wrong if you don’t stop to think for a second. Doctors deal with far, far more complicated questions, often without nearly enough time to stop and think. Education, training, and experience help, but doctors are all human, after all.
Dr. Robert Centor – a highly experienced, trained doctor who teaches and writes about this problem still ran into it himself with a patient of his:
So I share an important lesson. When you think you have found the answer, ask yourself whether there are other alternatives. We did not close down our search. The alternative diagnosis fits some of the data well, but there are a few confusing clues. I think in retrospect that I did not give enough weight to one symptom that fits the new diagnosis significantly better than the first “aha” moment.
This is a treatable disease and we can expect the patient to do well. As I said in my first post, persistence trumps brilliance. We were not so brilliant as we were stubborn and persistent.
Here’s to stubborn persistence.