Why Doctors Don’t Listen

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9.73 minutes.

According to a recent study, that’s how long the average doctor spends with you in the examining room before passing judgment with a prognosis and sending you home with a treatment program. Which is usually a prescription to treat the presenting symptoms, not the underlying cause. And because so little time and effort is taken to effectively diagnose the underlying source of the problem, very often the recommended treatment doesn’t actually work to relieve the symptoms. Consequently, many patients continue to suffer in silence, confused and frustrated by the doctor’s apparent inability to solve the problem.

Sometimes, after an insufferable escalation of the symptoms, an increasingly uncomfortable and irritated patient might summon the courage and return to the doctor’s office to question the validity of the initial diagnosis and the effectiveness of his treatment program. Whereupon the same doctor might perform another only slightly less perfunctory examination, normally sending the patient home with a new prescription—once again focused primarily on treating the presenting symptoms, not necessarily the underlying cause of the malady.

If and when the doctor finally admits that he doesn’t actually know what is causing his patient to be sick, the standard protocol is to order more tests and/or refer the patient to a specialist. This specialist, whose judgment is normally already biased by the patient history and initial diagnosis passed on by the presenting physician, barely gives the patient more time the second time around, typically averaging fifteen minutes or less. And so the cycle renews, with the patient’s suffering continuing until somebody finally correctly diagnoses the real cause of the problem—or the patient gives up and learns to live with his symptoms indefinitely.

Sound familiar? Each year, an estimated sixty million patients go home with a misdiagnosis of their health condition by their attending physician and needlessly suffer untold pain and anxiety. Hospital autopsies regularly reveal that at least twenty percent of serious patient illnesses are misdiagnosed. One study estimates more than 250,000 persons die every year from one form or another of doctor error, making it the third-leading cause of death in the United States after heart disease and cancer. Yet many of us still ascribe God-like qualities to our physicians—predominantly because we believe them to be the unique custodians of essential medical facts, and because we depend on them for our very lives and everyday health.

To be sure, most doctors are indeed smart—they couldn’t meet the high entrance requirements at medical school, nor pass the many complex and challenging tests along the way to receiving their diploma, if they weren’t. But the fact of the matter is that doctors are very human, and just as flawed as the rest of us when it comes to the practice of their profession. Perhaps even more so―not least because many of them have come to believe in their own infallibility.

Consider for a moment how doctors are trained. According to Dr. Jerome Groopman, who teaches Medicine at Harvard University and who recently penned the New York Times bestseller How Doctors Think, during the first two years of medical training, students are taught to learn basic human anatomy and physiology. In the last two years of medical school, they learn about known human diseases and the normal symptoms that are associated with these diseases. There are one or two courses that show how to gather a patient history and diagnose illnesses based on a method of correlating observed symptoms with known diseases—a technique Dr. Groopman calls ‘heuristics’. But the primary method for learning how to diagnose illnesses occurs after the medical students graduate, when they follow more experienced doctors on hospital rounds during their residency and watch and listen to how these other doctors perform their duties. In other words, doctors at most medical schools and hospitals are learning and being reinforced in the same manner of diagnostic problem solving that has been passed down for centuries (literally since the time of Hippocrates), which is to quickly correlate symptoms expressed during a normally short and cursory examination with a vast body of information about associated diseases—from the top of their head!

Maybe doctors really are God. At least they’d better be, using this technique. Once in a while of course, they get it right. But many of you probably know from your own experience and from the experience of your friends and loved ones, how often they get it wrong. So who can you depend on to look after your best interests, and provide you with the highest quality medical care? Your doctor is largely driven by the immediate demands of his overflowing patient waiting room, which in turn is driven by HMO fee structures that encourage too-short patient consultations, which likewise are driven by short-term corporate profit expectations—the same corporate interests that seem to have beholden and besmirched the motivations of your local Congress member. So who’s left? From top to bottom, it seems everyone in the ‘value chain’ who is supposed to be carefully managing your health care and providing oversight, has lost sight of the ultimate consumer.

It looks like the only one left is you. Like the old adage says: if you want a job done right, you’ve got to do it yourself. But we’re not talking about remodeling your family room or changing the oil in your car; we’re talking about optimizing your personal health, which means trying to fix a system of pipes and conductors that is infinitely more complex than that of your home or automobile. How could you possibly expect to take over the job of your family physician?

We’re not advocating, of course, that you fire your doctor and begin self-diagnosing and self-medicating yourself every time you have an illness. But the fact of the matter is that you are the person who is most motivated to solve your personal health problem – as well as the person who is the custodian of the most critical information of all, which is the history of your own illness and the associated events and experiences that may have caused it. Perhaps, if you really want to ensure your best interests are being taken care of, you need to take a more active role in the management of your health—and the in management of your personal physician.

By Reid Jenner

Comments

  1. As a patient with Gastroparesis, I believe that 10 min is not an efficient amount of time for an appointment. That is not enough time to even share what is wrong with my doctor!

    I have had experiences with many doctors that always seemed to be in a rush. As a result, I always left their office feeling confused because many of my questions were left unanswered or upset because the doctor didn’t truly listen to my ailments/concerns. It was like he/she came with diagnosis already determined before they ever spoke to me. I walked away from these appointments very dissatisfied.

    On the other hand, I have had about 3 doctors that stand out as being AMAZING. They always took their time, seemed to have my needs as their priority and embarked in a detailed 2-way conversation about my condition. As a result, I respected their opinions and felt validated as a patient.

    For optimal healthcare, especially when you have a complex disease like mine, teamwork and communication between a doctor and their patient is essential! I believe that if a doctor spent an ample amount of time with their patient (which is different for each appt) the medical issues can be resolved more effeciently and the number of visits by that patient will decrease.

    In conclusion, limiting appointments to 10 minutes is not a sufficient amount of time to spend with most patients and would be detrimental to our healthcare system.

  2. This is the best article I’ve read in a long time. You wrote what most patients think but are too afraid to say. Right on. I just bought your book.
    I am one of the patients you talk about. A 16 month severe lower abdominal pain condition landed me in 12 physicians’ offices in effort to find an accurate diagnosis and treatment plan. 10 misdiagnoses later plus 15 tests and treatments , I found my own diagnosis and the surgeon to heal me. I had an inguinal hernia with a nerve passing through the hole and muscle tears in my C section site with nerves passing through the tears.
    I was very lucky. I’m grateful. But what about the 1 in 20 who get misdiagnosed, the 40,000-80,000 who die every year because of diagnostic error? I hope the IOM report, due out this fall, spurs change.

  3. Reid

    Martine,

    Virtually every person I talk to has a horror story like this, either about themselves or a loved one. This is why I embarked on this journey, where I’m trying to educate and empower people to take more control over their health and not just blindly always trust their health care professional to do the right thing.

    I’m so glad you found a solution for your issue and finally found a physician who could heal you. Please let me know what you think about my book, and let me know if I can help in any way with applying the tools or helping you become a more empowered patient!

  4. Jeri Nasci

    I’ve actually been told to my face by a rheumatologist that I do not have sarcoidosis. After grilling me and asking how I was dx, I confirmed that a biopsy was done among other definitive symptoms ie: erythum nodosum, he was still not convinced and shooed me away flippantly telling me there was nothing wrong with me. This is not the first time and I’m sure, won’t be the last.
    I have only found a small handful of doctors that even know what sarcoidosis is. Because the rest do not know or understand, it’s much easier to blow you off or make it seem as if it’s all in your head. I hear this all too often being in forums with other sufferers of this insidious illness so I’m relieved to find that I’m not the only one being treated with such disdain. Because of this, I treat myself.

    1. Reid Jenner

      Thanks for sharing your experience, Jeri. I’m not sure what creates this kind of attitude with many doctors. Whether it’s their medical training, or the rush to get through their heavy patient load, or just thinking their patient has no place trying to solve their own problem—it’s infuriating and often life-threatening. In the end, we always need to accept the ultimate responsibility for our own health.

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