I'm in the middle of the Heath brothers' book Decisive. On pp. 104-107, they bring up the problem of a doctor who doesn't really listen to his patient but quickly diagnoses probably causes for what afflicts him. In one case, the patient was even put through a battery of tests, as well as a regimen of medications, for what he had identified as dizziness. It took a visit with a doctor who not just asks the right questions but notes the patient's answer to realize that he meant a kind of mental or emotional confusion due to feeling lost after his wife's death rather than physical ailment.
Unfortunately, such misdiagnosis is fairly common. Doctors are very likely to chalk up complaints to what they've learned is the major cause.
In the case described in the book, this led to unnecessary tests and useless treatments, which are a drain on resources and physically taxing. But in other cases, doctors claim nothing is really wrong with the patient. One of my online connections shared this clip from the Golden Girls series today:
I think I may have seen it before, but it particularly resonated with me today in light of the book's revelation and with my own experience of real harm caused by misplaced confidence in a doctor's diagnosis. In Dorothy's case, she wants the doctor to know that his dismissal of her signs of illness as the standard effects of aging caused her great emotional pain. Even without finding a cure for her condition, knowing that she wasn't simply losing her energy as a result of growing older was a comfort to her.
This really hits home for me now because a year ago, my mother had the same problem. At the age of 87 she underwent hernia surgery because she was told that would rectify her condition that was causing her pain. The surgeon didn't use the techniques for operations today in which incisions are minimized but cut her straight down the abdomen with a single, very long cut. He considered the surgery a great success and told her he wrote it up for a journal. But she continued to be in pain that just grew worse, and she revisited the hospital a few times after the surgery.
Each time she spoke with her surgeon, he dismissed her complaints, saying recovery takes a while and suggesting she speak with a psychologist about her feelings. He said it so confidently that one of my siblings who accompanied her on her visits believed it absolutely. That belief persisted even when she got the diagnosis of the real cause of her persistent pain - pancreatic cancer.
It took a while to get that diagnosis, and at that point it was quite advanced and not at all treatable (though some in the family remained in denial all the way until the just three days before her death). Given her age and condition, it is unlikely that her life could have been prolonged even with an earlier correct diagnosis, but that's not the full problem that results from I call undiagnosed malpractice.
I think I may have seen it before, but it particularly resonated with me today in light of the book's revelation and with my own experience of real harm caused by misplaced confidence in a doctor's diagnosis. In Dorothy's case, she wants the doctor to know that his dismissal of her signs of illness as the standard effects of aging caused her great emotional pain. Even without finding a cure for her condition, knowing that she wasn't simply losing her energy as a result of growing older was a comfort to her.
This really hits home for me now because a year ago, my mother had the same problem. At the age of 87 she underwent hernia surgery because she was told that would rectify her condition that was causing her pain. The surgeon didn't use the techniques for operations today in which incisions are minimized but cut her straight down the abdomen with a single, very long cut. He considered the surgery a great success and told her he wrote it up for a journal. But she continued to be in pain that just grew worse, and she revisited the hospital a few times after the surgery.
Each time she spoke with her surgeon, he dismissed her complaints, saying recovery takes a while and suggesting she speak with a psychologist about her feelings. He said it so confidently that one of my siblings who accompanied her on her visits believed it absolutely. That belief persisted even when she got the diagnosis of the real cause of her persistent pain - pancreatic cancer.
It took a while to get that diagnosis, and at that point it was quite advanced and not at all treatable (though some in the family remained in denial all the way until the just three days before her death). Given her age and condition, it is unlikely that her life could have been prolonged even with an earlier correct diagnosis, but that's not the full problem that results from I call undiagnosed malpractice.
The problem is that people who are in real pain cannot get the relief they need -- both in terms of medications that could alleviate the physical effects and in terms of the psychological relief of being understood rather than dismissed.
The refusal to see what the real cause was also caused problems in the family, as some member insisted on clinging to the belief that the cancer could be overcome when it could not. And that brings me to another form of malpractice from doctors.
The refusal to see what the real cause was also caused problems in the family, as some member insisted on clinging to the belief that the cancer could be overcome when it could not. And that brings me to another form of malpractice from doctors.
In their insistence on clinging to false hope, some members kept shopping around for those who would tell them what they wanted to hear. My mother was pulled out of the hospital that had diagnosed her correctly because they had brought up the possibility of hospice for palliative care.
The next hospital's doctors also could offer no hope because they were honest. So when my mother was in the facility for rehab, she got taken out to meet with another doctor who made it a point of policy to always extend hope, even offering some form of chemo with the idea that it could have the placebo effect even when it could not possibly cure the condition.
The next hospital's doctors also could offer no hope because they were honest. So when my mother was in the facility for rehab, she got taken out to meet with another doctor who made it a point of policy to always extend hope, even offering some form of chemo with the idea that it could have the placebo effect even when it could not possibly cure the condition.
This was a complete disaster because even he could not admit her to treatment but would not say so outright, claiming that she just had to get her strength up and want it. That was absolute poppycock that was insulting to the patient as well as her family.
Of course, she was growing weaker each day and being in a facility in which there was no great expertise on the kind of pain management she needed and where medicines and food were continually administered orally resulted in her being unable to sleep, in constant pain or nauseous and delirious, and, ultimately, contracting pneumonia. She returned to the hospital that could not do much for her and recommended she be moved to a hospice.
Of course, she was growing weaker each day and being in a facility in which there was no great expertise on the kind of pain management she needed and where medicines and food were continually administered orally resulted in her being unable to sleep, in constant pain or nauseous and delirious, and, ultimately, contracting pneumonia. She returned to the hospital that could not do much for her and recommended she be moved to a hospice.
She moved there on a Friday and only lived until Sunday and was barely conscious during that time. Had the doctor not offered false hope, she could have entered palliative care sooner, enjoying a more pain-free last few weeks with family that would not have been as restricted from visiting as they were at the hospital.
