Monday, November 3, 2008

Did Your Doctor Get it Right?

The latest from MSNBC is an article about questioning your physicians diagnosis called Did your doctor get it right? The premise is that commonly presenting symptoms are not always what they seem and your physician may mistakenly treat the wrong condition. Persistent cough vs. asthma, anxiety vs. arrhythmia, sinus infection vs. migraine, post nasal drip vs. Laryngopharyngeal reflux and urinary tract infection vs. interstitial cystitis are the five diagnosis that are discussed.

Stacey Colino, the author of the piece who is not listed as a physician or health care professional invites patients to "sleuth out what’s actually making you sick so you can find the right remedy and feel better fast."

I don't have any problems with the factual material of the article, other than the weight of the evidence (migraines and laryngopharyngeal reflux are probably missed more frequently, whereas most persistent coughs in adults are not likely new onset asthma). However, the notion that your doctor has no clue, and you should be your own detective is a unwise suggestion.

Physicians, myself included, do not get all diagnoses right the first time. That said, figuring out your own disease on your own is probably not the best alternative. Medicine is tricky. I see sinusitis and upper respiratory tract infections every single day, and they all present slightly differently in different patients. One of the interesting things about primary care is how unique everyone's "common" illnesses are; both the diagnosis and how the illness affects patients' lives. In addition to years of training, what a physician has is the years of experience to sort out what the actual problem may be. This experience can not be learned just by completing medical school, and certainly not on the Internet.

Instead of trying to "solve the case" case as "doctor" Colino suggests, here are some tips to help you and your physician arrive at the correct diagnosis when you have a medical problem.

1. Don't leave anything out. In medical school, we train our students to ask the right questions to help ascertain all the clues to determine the correct diagnosis. However, we can not read minds. If there is something else bothering you, regardless of whether or not you may believe it is connected, please mention this. This could be as simple as stress at work, a change in diet, a seemingly mild and unrelated symptom. Your physician may reassure you that indeed this is not likely related, but it is important to mention everything that is going on.

2. Understand your diagnosis. Once a diagnosis is made, you should not only understand what you have, but why your physician feels this way and why he or she is recommending the treatment given. Not only is this important so you can understand what is happening, but also because a misunderstanding or correcting the physician's perceptions of your illness may lead to the correct diagnosis.

3. Have a plan. Your physician should not only tell you what you have, but also when you should expect to feel better and what things to look out for that could possibly go wrong or lead to a different diagnosis. Antibiotics typically work in a day or two, so if you are not feeling substantially better, there could be a problem. Conversely, upper respiratory infections caused by viruses can take up to two weeks (sometimes longer) to resolve. If patients know what to expect, they won't be trying to solve their own medical mystery when things haven't improved quickly.

4. Communicate. Problems occur when patients don't communicate with their doctors. The article would suggest for example that if your cough isn't going away you might have asthma. You might look this up on the Internet and then either try a relative's medicine or take some over the counter Primatene Mist. This would be a huge mistake. As above, you should have a plan. When that plan doesn't go as expected, don't just ditch your doctor and solve your own problem. Call the physician and let them know you are not getting better. Response to treatment helps confirm a diagnosis or suggest a new one. In this specific case, I would probably re-evaluate the patient, possibly order more tests such as a chest X-ray, and try alternative medications (which are generally safer then over the counter meds and using someone else's prescriptions).


Unknown said...

You have more faith in your peers than I do as a patient.

Doctors are human, and can't always spend the time necessary to get it right all the time. A doctor should be questioned if the patient doesn't understand something, has heard/read/told conflicting information, or doesn't think he's getting a straight answer. I question my doctor without hesitation, and he encourages his patient to take an active role in their care because he can't know it all or have infinite time to care for all his patients like he wants to.

In the end, it is the responsibility of the patient to take care of themselves.

Dr. Matthew Mintz said...

I did not mean to imply that patients should not question their physicians. Patients have the right and responsibility to ask questions of their physician.
The problem with the MSNBC article is that 1)it implies that you shouldn't believe/trust your physician and 2)suggests that if you think your physician has not diagnosed you correctly, you should become your own detective and solve the problem on your own. This is not the way to go.
I do have faith in my peers, but know that they (myself included) can not be right all the time. Trust your physician, but ask questions if you are uncertain about the diagnosis or don't understand something. If things are not going as expected, don't start Googling your symptoms as the MSNBC piece implies, but rather communicate with your physician.