Do Your Doctor's Job (October 6, 2015)
When I say to do your doctor’s job for him/her, I don’t mean that you should take out your own appendix, like I’m pretty sure I once saw MacGyver do. I also don’t mean that you should make a practice of going to your doctor with the demand that s/he write you a prescription for some junk you saw advertised on television around 2:00 a.m. (or, even worse, in prime time). What I do mean is that if you shoulder some of the load in an area that is technically your doctor's responsibility, you can greatly decrease your chances of becoming a Medical Statistic.
Specifically. If you start your medical journey with an incorrect diagnosis, you’re probably toast. You wouldn't believe how long it can take to realize that a rash is actually from lupus if some chucklehead started off by assuming that it was from that Walmart 72-Hour Glow Blush that you bought on sale.
My advice is to avoid this happening to you if at all possible. And it just so happens that there is something very, very effective you can do to make it far less likely. It is something that is very much under your control. You can tell us exactly what is going on with you -- in doctor lingo, you can give a good medical history.
You may not have thought about this much if you still have that childlike faith in the wisdom of doctors and the medical industry that is so touching to see in people who are otherwise mature and intelligent adults. But trust me. Once you've chomped down on that bullet and are actually finally speaking to your doctor (or to the back of her computer screen, anyway), you must do everything in your power to help him or her figure out what is really wrong with you by telling him/her clearly what it is that is going on.
This is vital. Many people have way too much respect for diagnostic testing and think that what they have to say is not very important compared to the decree of an expensive test. They have it exactly backwards.
A good history is still crucial, even in light of the power we have today to measure each and every stupid little thing we can imagine about someone's body. Here is a dirty little doctor secret for you. The absolute best way to figure out what is actually wrong with someone is to LISTEN TO THEM. The Experts say that 70-90% of the job of diagnosis is based on the patient’s history, and in my experience it’s closer to 90% than 70%.
Doctors know this. “Helping patients communicate their symptoms clearly could go a long way toward making an accurate diagnosis” was the somewhat pompous pearl of wisdom that began an article I read recently. A whole lot of other things could as well, of course. Like, doctors could revive the lost art of physical examination and actually look at and maybe even touch their patients once in a while. In a perfect world, you would not have to worry about all this. But let's certainly not go there.
When we have so many expensive fancy tests that can measure so much different stuff, why is a history still so useful? Many reasons. One is that, unlike every single medical test out there, your history is 100% accurate. For example, if you get nauseous every time you eat a Philly cheesesteak (and you should, too) that is an indisputable fact. What you feel and experience is not subject to dispute or second guessing.
Personal history is 100% accurate but testing, you see, is not. Medical tests are always finding things that are not really there (false positives) or are meaningless in terms of disease, and missing stuff that really is there (false negatives). Medical dramas to the contrary, the number of times that a test accurately discerns a problem that no one had any other clue about are relatively few.
Additionally, many problems have a giveaway symptom or factor that identifies the problem right there. “This rash is right where that tick bit me about six weeks ago.” Score! Even when that's not the case, the more information you can give, the more you immediately narrow down the possible reasons for your problem and maybe saved yourself all kinds of misery (and money, too. Those tests are EXPENSIVE).
A good history, then, is crucial to good diagnosis and thus good treatment. But 75% doctors interrupt the patient’s history telling after an average of 18 seconds, and only 2% of patients eventually go back and finish their original thought. Wow, think there’s any relationship there between that and medical errors being our third leading cause of death? Maybe, because diagnostic errors are considered to be the most common type of medical mistake.
What does this mean to you? Your part is to make sure that your doctor is working with as much information, and that it is as complete and accurate, as possible. Marshal all the facts about your problem in an orderly little narrative before you even go to the doctor.
The first thing to do here is to PAY ATTENTION to your problem. This is not a natural thing to do. We get by from day to day by ignoring no end of physical issues. But once you get to the doctor, you have to be able to give information about it, so don't wait until you are asked.
In our doctorly wisdom, we consider that there are generally eight aspects to a symptom and/or problem that we want to know about. This is what you need to think about ahead of time:
1) Where it is.
2) When did it start/how long have you had it? and what was happening then?
3) Is it getting better? worse? more/less frequent?
4) Does anything else happen with it?
5) What does it feel like?
6) How bad is it?
7) What makes it worse?
8) What makes it better?
After a few years of practice, a good chiropractor can usually diagnose your pain issue after talking to you for five minutes or less. And since most problems are common problems, I'm willing to bet that the same is true of most medical doctors who know their stuff -- even if they have to confirm their opinion with further testing.
So, once again, don't underestimate how important your role is in getting better. Especially this role. Important enough that I'm going to elaborate on the above next time.
--dr. diane holmes
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