====HOW DOCTORS THINK!== this might help- seeing a new OR old doc

Discussion in 'Fibromyalgia Main Forum' started by victoria, Aug 23, 2008.

  1. victoria

    victoria New Member

    a friend posted this to me, it's about an article that appeared in AARP magazine about a book with the same title as this post, written by Dr. Groopman:

    "I'm sure we've all been faced with this very thing.
    The doctor is trying to place the info the patient gives into a pattern but
    -1. The patient may give "incomplete or misleading information" due to feeling uncomfortable

    -2. The patient's case may not be 'typical'. How the doctor handles this information can lead to several different diagnoses.
    The 3 major "cognitive mistakes" that lead to misdiagnoses this article states are:

    a. Grabbing on the first symptom, physical finding or laboratory abnormality ("anchoring"). This can lead to snap judgements, which may or may not be correct.

    b. What is most readily available in the doctor's memory can explain correctly or incorrectly what he or she is trying to diagnose. ("availability")

    c. The doctor will mentally invoke a stereotype and attribute symptoms ("attribution") to it such as if the patient is elderly that he or she is a complainer, hypochondriac or unable to cope due to naturally declining abilities.

    (Or perhaps a doctor thinks that a person with CFS/FM is really just a malingerer, is lazy and picking up on the latest 'fad', or has mental problems.)

    One example (in AARP magazine) was given of an older woman who was misdiagnosed with Alzheimer's. The family got a 2nd opinion from a different hospital's neurologist.and was diagnosed with a B12 deficiency, which is what was causing the memory problems.

    The writer mentions 3 questions to ask to prevent doctors from straying to an incorrect diagnosis.

    1. "What else could it be?" could get the doctor out of his/her "anchored" and familiar thinking.

    2. "Could two things be going on to explain my symptoms?" A doctor may stop searching when he/she finds an initial problem even if the patient doesn't completely get well.

    3."Is there anything in my history, physical exam, lab findings, or other tests that seems not to fit with your working diagnosis?" The doctor may be ignoring contradictory data if he/she remains locked in his/her diagnosis.

    Dr. Groopman, who wrote 'How Doctors Think', mentions that research shows that "most doctors interrupt a patient within 18 seconds of beginning an interview."

    We patients don't stand a chance...

    also here's an NPR interview and excerpt:

    [This Message was Edited on 08/23/2008]
  2. SpecialK82

    SpecialK82 New Member

    Good information to know!

  3. mbofov

    mbofov Active Member

    I saw Dr. Groopman being interviewed on PBS several months ago. It was very interesting, and scary from a patient's perspective. It seems that doctors' minds, in general, are pretty well closed, and often do think in stereotypes, etc. as you set forth.

    It's good information to have - thanks for posting -

  4. victoria

    victoria New Member

    as we've had friends who were doctors over the years. 'The system' puts everyone between a rock and a hard place, especially when it comes to rx'ing appropriate/necessary pain meds. And quite often MediCare won't even pay for what it costs the doctors for some vaccines, much less anything for overhead etc, yet it will not negotiate with the drug companies as other countries have.

    Sadly, I would never encourage my kids to be a doctor unless it was a 'calling'... our doctor friends have told their own children the same. &, only one's kids became doctors (their own decision however... 2 out of their 4 became docs).

  5. FMsaddenedspirit

    FMsaddenedspirit New Member

    Thank you for this information ,