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Every Patient Tells a Story

Every Patient Tells a Story. Lisa Sanders M.D. Diagnosis: Mysterious Psychosis. 70-90% of diagnoses are made based on the patient’s history alone. . Diagnostic Triad. Patient. Story. Diagnosis. Doctor. Diagnostic Triad. Patient. Story. Diagnosis. Doctor. Diagnostic Triad. Patient.

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Every Patient Tells a Story

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  1. Every Patient Tells a Story • Lisa Sanders M.D.

  2. Diagnosis: Mysterious Psychosis

  3. 70-90% of diagnoses are made based on the patient’s history alone.

  4. Diagnostic Triad Patient Story Diagnosis Doctor

  5. Diagnostic Triad Patient Story Diagnosis Doctor

  6. Diagnostic Triad Patient Story Diagnosis Doctor

  7. 5 doctors in 5 different practices in urban and rural England • 80 patients without a diagnosis • Each doctor recorded their differential diagnosis after each step of the evaluation: history, physical, test results Hampton, BMJ 1975

  8. Correct diagnosis made after: • History 68% (66/80) • Physical exam 9% (7/80) • Testing 9% (7/80) Hampton, BMJ 1975

  9. 4 physicians in practice is Utah • 80 patients without a diagnosis • Each doctor recorded their differential diagnosis after each step of the evaluation: history, physical, test results Peterson BMJ 1992

  10. Correct diagnosis made after • History 76% (61/80 ) • Physical exam 12% (10/80) • Testing 11% (9/80) Peterson BMJ 1992

  11. Patients spoke for an average of 23 seconds before the physician interrupted them with a question • Some physicians waited only 3 seconds before interrupting the patient

  12. Doctors were more likely to interrupt if the patient was a woman than if it was a man • Male doctors were more likely to interrupt than their female counterparts

  13. 2% of patients resume their story after being interrupted. • When interviewed after a doctor patient encounter, doctors and patients did not agree on what the encounter was about • Most patients had problems they didn’t get to address

  14. Why doctors miss the story: • Time pressure

  15. The average in-office doctor visit lasts 16-22 minutes

  16. Most stories last 60 seconds and none lasted longer than 150 seconds - 2.5 minutes

  17. Visits where doctors did not interrupt lasted on average 1 minute longer

  18. Krista’s Story

  19. Lemierre’s Syndrome External Jugular vein

  20. Why doctors miss the story: • Lack of training

  21. Why doctors miss the story: • Discomfort with patient emotions

  22. Dan’s Story

  23. 55% of patients surveyed said that their greatest concern after seeing a doctor was a misdiagnosis

  24. Up to 15% of diagnoses made in primary care specialties will be wrong

  25. “An estimated 40,000-80,000 hospital deaths result from misdiagnoses annually.” Newman-Toker, JAMA, 2009

  26. Ask your doctor: “What else could this be if it’s not that?”

  27. Tell your story - even after you’re interrupted

  28. Diagnostic Triad Patient Story Diagnosis Doctor

  29. Between 2-3% of patient leave the hospital AMA (Against Medical Advice)

  30. 25-50% of patients do not take their medications as prescribed

  31. Andy’s Story

  32. Andy: Linds, something's wrong Lindsay: what do you mean? Andy: my memory is all f'ed up Lindsay: what is wrong? Lindsay: call the DOCTOR NOW! tell them it is an emergency. Lindsay: How is it all f'ed up? Andy: short term, i can't remember anything

  33. Limbic Encephalitis

  34. Diagnostic Triad Patient Story Diagnosis Doctor

  35. Thank you

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