Inside a Doctor's Diagnosis

Sure, doctors are highly trained -- but they're still only human. And sometimes they're wrong about what's wrong with you.
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Getting the Most Out of Your Doctor

Is it possible to get good medical care from a doctor visit that lasts just 15.7 minutes? That's the average amount of time patients spend with their physicians per visit, according to a recent study from the Texas A&M Health Science Center -- and it includes both the physical examination and any time you spend talking about your problems and treatment. If your visit is average, you and your doctor will discuss about six separate concerns, spending some five minutes on the major topic and allotting a little more than a minute to each of the others.

This doesn't leave much opportunity to have a thoughtful discussion about your health, especially if you have several worries. Adding to the challenge: A doctor typically interrupts a patient after an average of 18 seconds, according to a landmark study from the '80s.

Then you face another challenge: getting your physician to give you enough time to explain what's going on before he or she arrives at a diagnosis and treatment plan. While doctors are encouraged to include patients in medical decisions -- a practice known as "informed decision making" -- not many have embraced the concept, according to a 1999 study in the Journal of the American Medical Association. They argue that there isn't enough time and question whether patients really want to be so involved.

Many physicians don't even tell patients why they are ordering a laboratory test or prescribing a medication. A 2006 UCLA study in the Archives of Internal Medicine reported that often doctors don't discuss the purpose or potential side effects of medication or even the names of drugs they prescribe. This is a significant problem because understanding the risks and benefits of a treatment makes patients likelier to consent and adhere to it.

And it's not only patients who lose when there's a communication breakdown. Doctors who score poorly on patient-physician communication tests are likelier to be the recipients of complaints to regulatory authorities, a recent Canadian study published in the Journal of the American Medical Association found. They may even be sued more often: "The most frequent instigator of malpractice claims is the patient who feels insulted or ignored," says Richard Frankel, PhD, a professor of medicine at Indiana University School of Medicine and an expert in doctor-patient communication. "Many patients could sue because of a bad outcome but don't because they have a good relationship with their doctor."

Contributing to the communication shortfall is the pressure many doctors are under, in this era of tight finances and managed care, to see more and more people -- an average of 20 per primary-care physician every day, according to a 2002 study in the New England Journal of Medicine. This places working fast at a premium. Even doctors who want to draw out information from patients that can clue them in on less-obvious symptoms and help them make a correct diagnosis may simply not have time.

As a result, doctors often rely on various mental shortcuts called "heuristics." These techniques tell them that certain combinations of symptoms generally point toward a specific diagnosis: A patient with X, Y, and Z almost always has Q wrong with her. Heuristics work much of the time but they can also be cognitive traps that can make your doctor miss what might be a more unusual but correct diagnosis, at least initially. One sobering look at the ultimate bottom line? An analysis of autopsies published in the Journal of the American Medical Association found that doctors make major diagnostic errors 8 to 24 percent of the time.

What to do? From the get-go you need to be an active, engaged participant in your own healthcare. If you're lucky enough to have a doctor who does hear what you say and tries to keep you informed (see "3 Signs Your Doctor Is a Good Listener"), your part is to describe your health problems clearly, pay attention to the choices you're offered, and follow through on the treatment your physician develops with you, reporting back how it's working. If your doctor tries to steamroller you into passive-patient mode, push back by interrupting, asking for clarification, and showing that you want to be involved. Remember, the informed decision-making school of medical care is on your side, and doctors who don't practice it are out of step.

When you are being treated for an ailment, you also need to watch that your doctor is not falling into those cognitive traps, especially if the first attempt at treatment doesn't seem to be working. To be fair, not every doctor can be expected to get every diagnosis right the first time. But if after a week or two your symptoms don't resolve, fail to respond or worsen, speak up.

The following information will help you understand how your physician looks at you from the first moment you meet and which techniques he or she may be using to diagnose your problem. Use this guide to identify each technique and to respond, if you need to, in ways that help your doctor see you and your case in a fresh light.

Continued on page 2:  The "Doorway Diagnosis"


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