Friday, November 5, 2010

We See This Sometimes

Have you ever been to the doctor only to be let down with the words of the unknown/unexplainable "we see this sometimes." In Dr. Groopman's book, he presents a case of another doctor seeing a pediatric patient. He is uneasy at his findings but doesn't know exactly what to make of it. He even consults with a pediatric doctor who tells him, "we see this sometimes." The patient eventually ends up being diagnosed with acute lymphoblastic leukemia. The original doctor makes the following comment, "When you hear that sentence ('we see this sometimes'), reply, Let's keep looking until we figure out what is wrong or know the problem has passed." This is excellent advice.

If your doctor ever utters the words (or something similar), "we see this sometimes" and wants to leave it at that consider using the reply above. Another is to ask "what 's the worst thing that this could be. In asking what the worst thing this can be is, you are not being difficult or pessimistic but helping the doctor to generate at least one alternative diagnosis. A third question that could be posed to the doctor is "What body parts are near where I am having my symptom?" Be cautious in accepting a we don't know what is causing your symptoms diagnosis.

Dr. Groopman makes another excellent point when he says, "what we say to a physician, and how we say it sculpts his thinking. (This) includes not only our answers but our questions."

Do you have a story to share about having an unknown diagnosis?

Wednesday, November 3, 2010

Errors in Thinking

Have you ever seen someone and immediately jumped to a conclusion about him/her? Sure, we all have.

Dr. Groopman discusses some types of error in a physician's thinking. One of these is representativeness error. This error occurs when "thinking is guided by a prototype so you fail to consider possibilities that contradict the prototype and thus attribute the symptoms to the wrong cause." He gives the example of a man who presents to the Emergency Department with chest pain. From the look of him, he was a real outdoors man who was in great shape. His blood pressure and pulse were absolutely normal. A work-up for heart issues was all negative. The doctor diagnoses a muscle strain. The next day this same man comes in with an acute myocardial infarction (aka-heart attack). This is representativeness error in the physician's thinking. The man didn't fit the normal profile of a heart attack victim and his tests were all negative.

A second error in thinking that Dr. Groopman discusses in attribution error. He believes this is a more common error that occurs when a person fits a negative stereotype. You know, the guy who fits the bill perfectly for an alcoholic. However, this can be a mistaken stereotype. Perhaps, as the case presented in the book, the man has a rare disease. If the doctor just blows him off as another alcoholic, he will not diagnose or treat him properly.

Dr. Groopman makes an interesting statement in this chapter of his book. He says, "It (is) my job to be complete in my exam, and my charge to monitor my feelings when they might break my discipline."

As a health care provider, it is my job to be thorough and not to let my feelings cloud my judgment. I think we can all learn a lesson from these errors in thinking as we all fall prey to them at one time or another.

Any thoughts or stories of your own to share related to errors in thinking?