Diagnosis Solved! How to Solve a Medical Mystery

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Talking to Your Doctor

In your book Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis, you say that talking to your doctor is the key to diagnosis. So why is it so hard for doctors and patients to just talk?

The problem is that too many doctors are under extreme pressure. But it's a pressure they've allowed themselves to be put under. The amount of money doctors get paid for visits has gone down quite a bit, and they've tried to make up for it the old-fashioned way -- by seeing more patients than ever before in a much shorter amount of time.

But as a patient, that's not your problem. You need a doctor who gives you the time you need. Now, if you need three hours, you're going to have a very hard time finding a doctor. But if you think you need more than six minutes? Welcome to the club. We all need more than six minutes.

Patients need to exert the same kind of pressures on doctors that insurance companies do. You have to say, "I need this, and I can't help that you've scheduled a patient every six minutes. This doesn't work for me."

Doctors do it because the pressure from the insurers is real. They are like our bosses, and they think we should see a patient every six minutes. But patients have got to apply pressure in the other direction. I think that ultimately insurance companies will see that a doctor's time, no matter how expensive it is, is way more useful than even the cheapest blood test, the cheapest scan, or the cheapest surgery. I hope they'll start to see that sooner rather than later. Doctors order many of these tests simply because they're under such time constraints, and they don't have time to listen to the patient and think about it. So they just decide to see what the test reveals and deal with it later.

Patients are the ones who suffer. Doctors need to have enough time to listen to their patients and hear what they have to say. There's no other way to get that information except by talking. Only the patients can say how they feel, what hurts, what makes it worse and what makes it better. Those are really fundamental questions that we as doctors ask, and there's no test for that! It's been shown in many studies that 80 percent of the time a diagnosis is made based on the patient's story.

The bottom line is that you need to find a doctor who will give you the time you need. And if that means voting with your feet and finding a different doctor, then that's what you have to do.


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