The 18-Second Doctor
How did you figure it out?
I went and found the fourth surgeon, who was a young and very attentive surgeon, listened very carefully, and did something quite remarkable. Not only did he examine my right hand, but he examined my left hand. Not only did he get regular X-rays and an MRI, but he had an X-ray done when I used my hand, gripped something tightly. He saw that the space between two small bones in the wrist markedly widened. He said the ligament must have torn. It didn't show on the MRI. Everyone bows to the authority of technology, but these scans are not perfect. Errors in radiology range between 20 and 30 percent, which is remarkably high. And, indeed, he was right.
How can we avoid being misdiagnosed?
It's very appropriate for a patient to say, "I'm not getting better. I'd like to talk to you again about what's bothering me." Good physicians are receptive to that. If you really feel there is not communication with a doctor, and because communication is key to good thinking, then it's time to get a new doctor.
Can we change how doctors think?
Very much so. We should integrate deeply into medical education this new information about thinking errors that comes from cognitive psychology. It's the basis of misdiagnosis. The second is that we're working under such time pressure, and we think and act as doctors at the same time, in the moment. Patients or family or friends can ask just a few appropriate questions to help us avoid errors. What else can it be? The third question is: Is there anything that's been found that contradicts the presumed diagnosis? Those are the key questions.
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