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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 • 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 Story Diagnosis Doctor
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
Correct diagnosis made after: • History 68% (66/80) • Physical exam 9% (7/80) • Testing 9% (7/80) Hampton, BMJ 1975
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
Correct diagnosis made after • History 76% (61/80 ) • Physical exam 12% (10/80) • Testing 11% (9/80) Peterson BMJ 1992
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
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
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
Why doctors miss the story: • Time pressure
Most stories last 60 seconds and none lasted longer than 150 seconds - 2.5 minutes
Visits where doctors did not interrupt lasted on average 1 minute longer
Lemierre’s Syndrome External Jugular vein
Why doctors miss the story: • Lack of training
Why doctors miss the story: • Discomfort with patient emotions
55% of patients surveyed said that their greatest concern after seeing a doctor was a misdiagnosis
Up to 15% of diagnoses made in primary care specialties will be wrong
“An estimated 40,000-80,000 hospital deaths result from misdiagnoses annually.” Newman-Toker, JAMA, 2009
Ask your doctor: “What else could this be if it’s not that?”
Diagnostic Triad Patient Story Diagnosis Doctor
Between 2-3% of patient leave the hospital AMA (Against Medical Advice)
25-50% of patients do not take their medications as prescribed
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
Diagnostic Triad Patient Story Diagnosis Doctor