REMINDER: I AM POSTING A NEW TOPIC ABOUT ONCE A WEEK OR PERHAPS TWICE A WEEK. HOWEVER, IF YOU DON'T FIND A NEW TOPIC POSTED, THERE ARE AS OF MARCH 2013 OVER 900 TOPIC THREADS TO WHICH YOU CAN READ AND WRITE COMMENTS. I WILL BE AWARE OF EACH COMMENTARY AND MAY COME BACK WITH A REPLY.
TO FIND A TOPIC OF INTEREST TO YOU ON THIS BLOG, SIMPLY TYPE IN THE NAME OR WORDS RELATED TO THE TOPIC IN THE FIELD IN THE LEFT HAND SIDE AT TOP OF THE PAGE AND THEN CLICK ON “SEARCH BLOG”. WITH WELL OVER 900 TOPICS, MOST ABOUT GENERAL OR SPECIFIC ETHICAL ISSUES BUT NOT NECESSARILY RELATED TO ANY SPECIFIC DATE OR EVENT, YOU SHOULD BE ABLE TO FIND WHAT YOU WANT. IF YOU DON’T PLEASE WRITE TO ME ON THE FEEDBACK THREAD OR BY E-MAIL DoktorMo@aol.com
IMPORTANT REQUEST TO ALL WHO COMMENT ON THIS BLOG: ALL COMMENTERS WHO WISH TO SIGN ON AS ANONYMOUS NEVERTHELESS PLEASE SIGN OFF AT THE END OF YOUR COMMENTS WITH A CONSISTENT PSEUDONYM NAME OR SOME INITIALS TO HELP MAINTAIN CONTINUITY AND NOT REQUIRE RESPONDERS TO LOOK UP THE DATE AND TIME OF THE POSTING TO DEFINE WHICH ANONYMOUS SAID WHAT. Thanks. ..Maurice
FEEDBACK,FEEDBACK,FEEDBACK! WRITE YOUR FEEDBACK ABOUT THIS BLOG, WHAT IS GOOD, POOR AND CONSTRUCTIVE SUGGESTIONS FOR IMPROVEMENT TO THIS FEEDBACK THREAD
"Looking Back": Clinical Review and Reconsideration
It is only natural, if one has a memory, to look back with the remembrance of the event
and think to oneself whether the decisions made and the outcome of the event
could have turned out better if the issue was thought out and acted upon in a
different way. And it is only natural but
also part of the professional learning experience for a physician to look back,
reconsider and contemplate a different
approach to the diagnosing the illness, explaining the findings to the patient,
presenting to the patient professional advice and then different decisions made
with the patient. Looking back may
expose to the physician mistakes made, mistakes which can be prevented in
Mistakes can involve
errors of knowledge or related to assumptions regarding the clinical condition
but also about the patients themselves. Mistaken
conclusions by the doctor about the his or her patient may arise because of
insufficient time taken with the patient to obtain, beyond the biologic aspects
of the patient's illness, knowledge of the psychologic and social aspects of
the patient's life and the impact of the illness on it. The patient who is described as "non-compliant"
toward diagnostic procedures or treatments, after the fact, may have had issues,
which could be considered and attended to earlier, but unknown to the physician
because of inadequate history taking and earlier discussion with the patient.
Errors or delays in making proper diagnoses can often, on
looking back, be related to assumptions based on the medical literature or the
physician's experience with patients bearing similar patchwork of
symptoms. It is much easier to base a
conclusion on similarities to other cases than to start out with the approach
that the diagnosis of the present patient will be unique and require more
special and intensive intellectual attention.
Consultation of cases with specialists or others with assumed "more
experience", especially informal "curb-side" consultations
though often helpful to the physician, may provide inappropriate conclusions
since the specialist has not had the opportunity to talk with or examine the
patient of the case.
Treatment of the patient's disorder may be misguided by
erroneous "it has always worked before" assumptions but also by
paternalistic "this approach is the best for the patient" with some
alternate treatments not presented to the patient for the patient's
Failure of correct diagnosis or failure of treatment or frank
"medical/surgical mistakes" is always an underlying consideration by all
physicians but, at times physicians may have become unreasonably "optimistic"
regarding diagnosis and treatment. When
this optimism fails in results, as it can, there follows much personal
soul-searching and "looking back".
Yet, "looking back" really should be the final professional
act in cases that "go well" as
those that don't since every case should be a professional learning experience
and, without "looking back", looking forward may be missing something
important for the physician to know and,
in fact, leave the physician misguided. ..Maurice.
Graphic: Two Deer Looking Back--photograph taken by me at Red
Rock State Park, Sedona, Arizona, June 2013.