We often ascribe God-like qualities to our physicians, largely because we believe they are the unique custodians of complex and arcane medical knowledge, 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 most medicals schools nor pass the many complex and challenging tests along the way to receiving their diploma if they weren’t. But the fact 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, because many of them have come to believe in their own infallibility.
But the facts belie their confidence. Each year, an estimated 60 million patients go home with a misdiagnosis of their health condition by their attending doctor and needlessly suffer untold pain and anxiety. Hospital autopsies regularly reveal that 20% of serious patient illnesses are misdiagnosed. One study estimates more than 250,000 persons die every year from one form or another of physician error, making it the third-leading cause of death in the United States after heart disease and cancer. In most cases these misdiagnoses, along with the extended pain and suffering that goes along with them, could have been avoided with a more thorough examination and interactive patient dialogue.
Dr. Jerome Groopman, author of the best-selling book How Doctors Think, teaches medical students at Harvard Medical School. He points out that during the first two years of medical training, students are taught to learn basic human anatomy and physiology. In the next two years, they learn about known human diseases and the typical symptoms that are associated with these diseases. 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 physicians 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, which is to quickly correlate symptoms expressed during a short examination with a vast body of information about associated diseases from the top of their head!
Unlike other fairly scientific disciplines such as biology and even psychology, whereby practitioners typically gather a large body of data and carefully analyze it before drawing conclusions and making recommendations, researchers have consistently found that physicians normally form a loose hypothesis about the possible causes for their patients’ problem after a relatively brief and superficial examination. Studies show that in the classroom or other environments where their performance is monitored, doctors normally need a minimum of twenty to thirty minutes to arrive at a working diagnosis. But in the field, working with real patients, an experienced clinician typically forms an opinion as to the likely cause of their patient’s problem in as little as twenty seconds.
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 I suspect many readers know from their own experience, and from the experience of many friends and loved ones, how often they get it wrong. This is one of the reasons increasing numbers of people are turning to the internet to research or validate their doctors’ rushed diagnoses and invasive treatment plans [read my related article: Do Online Self-diagnoses Work?]. Unfortunately, many consumers have come to realize that just like remodelling your home, if you really want it done right—sometimes you’ve got to do it yourself.
By Reid Jenner