Rushing to a Diagnosis, Doctors May Listen Less

In medical school, I learned the art of medical questioning. We didn’t realize that to the patient it can feel like an inquisition.

When the “chief complaint” (Yes. That is the medical term for a patient’s main presenting concern.) is pain. We were trained to ask, “When did it start?” “Where does it radiate?” “What makes it better?” “What makes it worse?” “Is it worse with activity?” “Is it worse after eating?” “What kind of pain is it? Sharp or dull? Colicky? Lancinating? Crampy? Squeezing?”

When the pattern of your answers to our patter of questions seems to fit the typical presentation of a clinical syndrome (i.e. gallstones, peptic ulcer disease), our questions become even more focused and specific as our differential diagnosis (the broad range of potential diagnoses) quickly narrows to one specific diagnosis.

The risk of narrowing that differential too quickly is to force the patient’s symptoms into the tight box of the diagnosis we have in mind. That may very well be the wrong one.

Next: How some doctors are learning to slow down and listen.

 

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About Davidicus Wong

I am a family physician. I write a weekly newspaper column, Healthwise for the Vancouver Courier, Burnaby Now, Royal City Record and Richmond News.
This entry was posted in patient-doctor relationship and tagged , , , , . Bookmark the permalink.

4 Responses to Rushing to a Diagnosis, Doctors May Listen Less

  1. mysterycoach says:

    To be reasonable πŸ™‚ Do you remember my post about Doctors and Surprise Endings that I made a page for? In that, I had a stressful relationship and my symptoms were directly related to this person’s presence in my life. Something that I was “almost” ignoring but NOT ignoring because, I knew… I was busy hoping that wasn’t it. Of course, soon as that relationship was ended, which I knew I had to do. I was back to being myself Problem resolved.

    My thought process here is that much like I was lying to myself at the time as to my physical symptoms which were “indeed” being caused by A. my letting this individual stay in my life and B. I also misrepresented the cause to the doctor due to my own denial. πŸ™‚

    Now… having said this, is very important because people are not all that self aware. They make excuses for people and circumstances in their lives, denial really, and how on earth can a physician treat them in any capacity for the root cause if the person themselves is unaware of it.

    So, a good thought process to me is how on earth, does a physician, be presented with the physical symptoms I had brought on my stress and that particular relationship IF the patient is not aware and/or honest about it themselves.

    This, I would imagine, creates quite the conundrum for physicians all over … because the root cause is not readily apparent.

    • In some ways, a doctor or counselor can be like a best friend – someone who knows you well, listens to your experiences and reflects back what your life, your dreams, your actions and your body are trying to tell you.

      Sometimes the subconscious mind and our bodies give clues to our underlying problems but the conscious mind is not quite ready to accept them. I wouldn’t call this lying to yourself or to others. Sometimes we need someone we trust to wake up our conscious minds.

      • mysterycoach says:

        You’re way too kind, however in my particular case, I knew. πŸ™‚ My body has always been smarter even if my mind wasn’t paying attention. It would revolt in particular ways emotionally. Take the year before last, I was working a lot of over time, they had let someone go and one could say that I got the flu due to being over worked. That was not the case. My illness which presented like the stomach flu, and a very bad one within an hour of the “one more thing” that stressed me … was a direct result of my environment and the stress within it. In this particular case as well, “I knew’ some would poo poo that and suggest I made that up or it was just a coincidence.

        however, when my boss came up and I was already at my wits end, gave me that one additional thing to do? My entire body shut down, mind, everything… I went numb and felt nauseous. I know… I think, people tend to make excuses for these things. I’ve made them myself, I’m familiar with it.

        I think too at times we assume with more time, patience effort that some things can be resolved in a healthy manner. This is true in some cases, absolutely… for myself (as I can only speak for me of course) when I ignore the cause, should it be a person and their actions and the environment (much like my last job) … you know we tolerate way too much in life and this affects us on many levels.

        I had a friend who was married to this guy for 20 years and she got divorced. Voila! No more stomach pains … she had them all those years and it was directly related to that relationship. In that case, it wasnt’ realized until they broke up … but I think we know… I think we all know and in the hopes that things can be better, we … block it out. For good reasons I’m sure… but I truly, truly believe us humans tend to minimize the things that affect us physically, mentally, emotionally way too often.

        So many … twists and turns aye? LOL πŸ™‚

  2. mysterycoach says:

    Oh! As always πŸ™‚ a pleasure Dave !

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