“One of the most powerful things a patient said to me a few years ago was:‘The doctors want my symptoms, but not my stories.’I quote her ALL the time – the symptoms are in the story. This patient was a refugee, so her story was critically important to understand the whole picture.”
Emergency physician Dr. Pat Croskerry tells the story of the day he misdiagnosed a patient who was experiencing unstable angina – chest pain caused by coronary artery disease, and often a warning sign of oncoming heart attack. But this is what he’d said before sending that patient home:
“I’m not at all worried about your chest pain. You probably overexerted yourself and strained a muscle. My suspicion that this is coming from your heart is about zero.”
One of my blog readers needlessly suffered debilitating cardiac symptoms for a number of years before she was finally correctly diagnosed (thanks to a second opinion) with coronary microvascular disease(MVD). During those years, she’d read everything she could get her hands on in a desperate effort to solve this mystery. But when she asked her own physician if MVD might be the culprit, he dismissed this diagnostic possibility, adding that he “didn’t believe” in coronary microvascular disease.
Didn’t believe in it?!
Please note, darling readers, that we’re not talking about the Tooth Fairy here.
We’re talking about a woman living with a cardiac condition that’s been well-studied (as in, peer-reviewed studies done by respected heart researchers and published in actual real-life medical journals).
Until being misdiagnosed with indigestion in mid-heart attack, I generally trusted that all people with the letters M.D. after their names knew what they were talking about when diagnosing serious medical problems. That was long before I tracked down a study(1) reported in the New England Journal of Medicine that women under the age of 55 who are experiencing a heart attack are seven times more likely to be misdiagnosed and sent home from the E.R. compared to their male counterparts presenting with identical symptoms.
The trouble with Dr. Jerome Groopman‘s book, How Doctors Think, is that the docs who really need it won’t read it. But patients will, thanks to word-of-mouth buzz since it was published in 2007.
As a patient who has experienced a life-threatening misdiagnosis while having a heart attack, my own favourite part of the book is Dr. Groopman’s review of physicians who take cognitive shortcuts during patient visits.
This means that doctors can jump to conclusions about diagnosis or treatment options, and then can’t budge even when contradictory evidence subsequently emerges. “Blame the 18 Second Rule!” advises Dr. Groopman, professor of medicine at Harvard.