I found this book to be helpful and recommend it to those having difficulty receiving a medical diagnosis or who have been misdiagnosed. The following are excerpts from this book.
This book is about what goes on in a doctor’s mind as he or she treats a patient.
Evey doctor makes mistakes in diagnosis and treatment. But the frequency of those mistakes, and their severity, can be reduced by understanding how a doctor thinks and how he or she can think better. This book was written with that goal in mind.
Misdiagnosis is different. It is a window into the medical mind. It reveals why doctors fail to question their assumptions, why their thinking is sometimes closed or skewed, why they overlook the gaps in their knowledge. Experts studying misguided care have recently concluded that the majority of errors are due to flaws in physician thinking, not technical mistakes. In on study of misdiagnoses that caused serious harm to aptients, some 80 percent could be accounted for by a cascade of cognitive errors. Anothe study of one hundred incorrect diagnoses found inadequate medical knowledge was the reason for error in only four cases. The doctors didn’t stumble because of their ignorance of clinical facts; rather, they missed diagnoses because they fell into cognitive traps. Such errors produce a distressingly high rate of misdiagnosis.
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Physicians who dislike their patients regularly cut them off during the recitation of symptoms and fix on a convenient diagnosis and treatment. The doctor becomes increasingly convinced the truth of his misjudgment, developing a psychological commitment to it. He becomes wedded in his distorted conclusion. His strong negative feelings about the patient make it harder for him to abandon that conclusion and reframe the clinical picture differently.
This skewing of physicians’ thinking lead to poor care. What is remarkable is not the consequences of a doctor’s negative emotions. Despite research showing that most patients pick up on the physician’s negativity, few of them understand its effect on their medical care and rarely change doctors because of it. Rather, they often blame themselves for complaining and taxing the doctor’s patience. Instead, patients should politely but freely braoch the issue with their doctor. “I sense that we may not be communicating well,” a patient can say. This signals the physician that there is a problem in compatibility. The problem may be resolvable with candor by a patient who wants to sustain the relationship. But when asked other physicians what they would do if they, as patients, perceived a negative attitude from their doctor each one flatly said he or she would find another doctor.
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A wealth of research shows that patients thought to have a psychological disorder get short shrift from internists and surgeons and gynecologists. As a result, their physical maladies are often never diagnosed or the diagnosis is delayed. The doctor’s negative feelings cloud his thinking.
But as a growing body of research shows, technical errors account for only a small fraction of our incorrect diagnoses and treatments. Most errors are mistakes in thinking. And part of what causes these cognitive errors is our inner fellings, feelings we do not readily admit to and often don’t even recognize.
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“You can see many things on an MRI, but nothing that’s clearly responsible for the symptoms. So you begin to go around and around. The hateful part of MRIs - I mean they can be a wonderful technology - but they find abnomralities in everybody. More often than not, I am stuck trying to figure our whether the MRI abnormality is responsible for the pain. That is the really hard part.”
The key, is for “everything to add up - the patient’s symptoms, the findings on physical examination, what appears meaningful on the MRI or other x-rys. It has to come together and form a coherent picture.”
“We have so many excellent imaging techniques. Some doctors hardly examine patients or take histories anymore. They just order scans and say to the radiologist, ‘Give me a diagnosis.’”
“Even if different radiologists see the same thing on an image, just by the way describe it, there are nuances and ambiguities communicated by the terms.”
Machines cannot replace the doctor’s mind, his thinking about what he sees and what he does not see. Attention to language - the words of a referring clinician and the report of the radiologist - can make perception and analysis better. Laymen should understand the inherent limits and potential biases in the beholder’s eye, so that there are important decisions to amke, they can ask for another set of expert eyes.
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When a patient tells me, “I still don’t feel good. I’m still having symptoms,” I have learned to refrain from replying, “Nothing is wrong with you.” The statement “Nothing is wrong with you” is dangerous on two accounts. First, it denies the fallibility of all physicians. Second, it splits the mind from the body. Because sometimes what is wrong is psychological, not physical. This conclusion, of course, should be reached only after a serious and prolonged search for a physical cause for the aptient’s complaint.
The lingering stigma that exists in medicine, and in the larger society, about psychological distress and its ramifications through the body, stands as a roadblock to relieving the pain and misery of so many patients. Many doctors, as we have seen, dislike patients whom they stereotype as neurotic and anxious. These patients pose the greatest cahllenges to even the most caring physicians. They may relate their story in a scattershot way, hypersensitive to every ache and pain, and make it difficult for the doctor to focus his mind so that he finds the tumor in the breast or the noldule in the thyroid gland. A patient’s insight into his own thinking and emotional state can be enormously helpful to a physician.