Diagnosis Challenge: “It’s most likely..” vs “What Else Could It Be?”

“It’s most likely…” vs “What else could it be?” This is what is going on in the mind of a physician as he or she evaluates a patient’s symptoms to try to name a disease which the patient is bearing. A recent article by Jonathan Kay as written in the National Post describes the book written by Harvard Medical School physician, Dr. Jerome Goopman titled “How Doctors Think”. The article brings out a main point of the book that physicians should not close their minds to possible diagnoses that are beyond the diagnosis that first comes to mind. This is because it is not uncommon that doctors miss the correct diagnosis because they rely on their initial impressions (even based on stereotypes) or don’t acquire or listen carefully to all the facts or perform an incomplete physical examination. In fact, not only physicians should say to themselves “what else could it be” but, in fact, patients themselves should challenge their doctors by asking them the same question.

It is interesting that there appeared a comment to the Kay article challenging the advice for patients, especially in some emergency room situations, to even consider posing the “what else could it be” question to the ER doc.

Read the linked text.

Repeating what I wrote about in a previous post, I am in the process, over the past 5 weeks with 2 more weeks to go, of facilitating a 2nd year medical school course titled “Integrated Cases” which is designed to aid medical students who have learned all the biology and clinical facts of many diseases and are about to use these teachings on the wards with real patients during their clinical clerkships in the 3rd and 4th years, on how “doctors think” to make a diagnosis.
We hope to teach them the correct way to “think” out the medical problem. This thinking does involve making assumptions based on previous personal experience and the literature (“scripted method”) but also a careful detailing and analysis of the facts of the case (“analytical method”). Physicians also have to consider whether the cluster of symptoms that the patient presents represents a single active disease or whether these symptoms actually represent two or more diseases occurring simultaneously.

I personally am not against a patient asking the “what else could it be” question to their doctor. I think it is all part of the team work that both the doctor and patient are involved together within the doctor-patient relationship to attempt to solve and cure the symptoms and disease. ..Maurice.

ADDENDUM 5-16-2007: Listen or watch Dr.Jerome Goopman as interviewed on PBS "The News Hour" on 5-15-2007.