The KevinMD article, The Truth Behind Why Doctors Don’t Tell the Truth, rang true for me. After seeing 12 physicians of differing specialties for a severe, lower abdominal pain condition that lasted 16 months, I was offered 10 misdiagnoses. In addition, I endured 15 procedures and tests. In the end I uncovered my own diagnosis and the surgeon who healed me.
Dr. Kristin Prentiss, the author of the article, captured a list of reasons why physicians offer diagnoses they aren’t quite sure of. Unless physicians give patients diagnoses that insurance companies will accept, they won’t get paid. Among other reasons cited is the reality that doctors don’t want to be wrong. The words, “I don’t know” won’t get them paid and certainly won’t satisfy most patients.
What the author left out of her summation is that doctors don’t always listen to patients. William Osler, the “father of modern medicine” said, “Listen to the patient, he is telling you the diagnosis.” With 7-15 minutes per patient, it’s not hard to understand why doctors aren’t listening carefully enough to patients, not taking complete medical histories, not asking the patient enough questions, and making incorrect conclusions about what is wrong. With 20 million Americans misdiagnosed each year, something has to budge.
To add to the problem, patients tend to leave out important facts from their medical histories.
In my case, I didn’t leave out any facts. I came prepared for each medical appointment with a typed summary of my major medical events, including surgeries, one of which was a C-section. I also arrived at each doctor visit with copies of my medical records, medical history, list of medications and allergies to medications, symptom diary, and a list of questions. After interviewing 200 physicians and other medical providers for my latest book, The Take-Charge Patient, I implemented my own strategies.
During my diagnosis journey, I asked two of of the physicians, “How about an abdominal MRI?” I pointed directly to the location of the searing pain below my navel and described where it fanned out in spasm.
Did they listen? No.
Did any of the physicians read my medical history and list of surgeries in effort to make connections to my current chronic pain? Perhaps some did. They still missed it.
Do I think the doctors I saw were incompetent? Not in the least. Some were very focused on their specialization and others were just too busy cramming in patients that needed to be seen and didn’t have enough time to spend with me. Some were content with simply treating symptoms when the diagnosis didn’t immediately present itself. Most were tracking for the most common diagnoses, something that is taught in medical school. “If you hear hoof beats, think of horses not zebras.”
Regardless, I agree with what the author wrote; “Doctors walk a web of thin fibers between a patient’s expectations, our honest perceptions, and insurance companies’ requirements.” But she left out that lack of time is a major hindrance for doctors working the diagnostic process. Without enough time, physicians cannot sit down with patients to properly communicate and to fully listen to their stories. 7-15 minutes, and usually closer to 7-10, only allows for a brief overview and can so easily obviate a mutual dialogue and shared decision-making.
I made the time to find my own diagnosis because it was my body, my life that was being dismantled by pain. I found the correct diagnosis in this article in the New York Times, In Women, Hernias Can be Hidden Agony. When I read it, there was no ignoring my gut reaction. The patient depicted in the article had symptoms exactly like mine, pain just like mine, and had gone from a very active woman to one with pain that dropped her to her knees.
I couldn’t reach for the phone fast enough after I read it. I contacted the surgeon and hernia specialist, Shirin Towfigh, MD, who was featured in the article. Luckily for me, she was located in Los Angeles and affiliated with a highly respected teaching hospital.
Diagnosis? Muscle tears in my C-section site with nerves lodged in the tears, and an inguinal hernia (right next to it) with a nerve pinched in the hole.
Cure? Surgical repair.
I’ve been pain free for four years thanks to Dr. Towfigh. Not only did she make the time to review my medical history, medical records and symptom diary, perform a physical exam and order a high resolution dynamic MRI, but she listened to the patient. Her expertise and skill did the rest.Read More...