WWWWF:Deep Doc Thoughts II - Things That Make You Say Yeesh!
Interesting insights from How Doctors Think
From Pg. 17:
They have shown that how a doctor asks questions and how he responds to his patient's emotions are both key to what they term "patient activation and engagement." The idea...is "to wake someone up" so that the patient feels free, if not eager, to speak and participate in a dialogue. That freedom of patient speech is necessary if the doctor is to get clues about the medical enigma before him. If the patient is inhibited, or cut off prematurely, or constrained into one path of discussion, then the doctor may not be told something vital.
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Observers have noted that, on average, physicians interrupt patients within eighteen seconds of when they begin telling their story.
From Pg. 19
Hall discovered that the sickest patients are the least liked by doctors, and that very sick people sense this disaffection. Overall, doctors tend to like healthier people more. Why is this? ...Many doctors have deep feelings of failure when dealing with diseases that resist even the best therapy; in such cases they become frustrated, because all their hard work seems in vain. So they stop trying.
From Pg. 21
During my training, I met a cardiologist who had a deserved reputation as one of the best in his field, not only a storehouse of knowledge but also a clinician with excellent judgment. He kep a log of all the mistakes he knew he had made over the decades, and at times revisited this compendium when trying to figure out a particularly difficult case.
From Pg. 24
Experts studying misguided care have recently concluded that the majority of errors are due to flaws in physician thinking, not technical mistakes. In one study of misdiagnoses that caused serious harm to patients, some 80 percent could be accounted for by a cascade of cognitive errors ... Another study of one hundred incorrect diagnoses found that inadequate medical knowledge was the reason for error in only four instances. 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 misdiagnoses. As many as 15 percent of all diagnoses are inaccurate, according to a 1995 report... These findings match classical research, based on autopsies, which show that 10 percent to 15 percent of all diagnoses are wrong.
From Pg. 34
Studies show that while it usually takes twenty to thirty minutes in a didactic exercise for the senior doctor and students to arrive at a working diagnosis, an expert clinician typically forms a notion of what is wrong with the patient within twenty seconds.
From Pg. 35
Research shows that most doctors quickly come up with two or three possible diagnoses from the outset of meeting a patient -- a few talented ones can juggle four or five in their minds.