Transcript 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
Diagnosis
Doctor
Diagnostic Triad
Patient
Diagnosis
Doctor
Diagnostic Triad
Patient
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
• Physical exam
• Testing
68% (66/80)
9% (7/80)
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
Peterson BMJ 1992
11% (9/80)
• 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
• The average in-office doctor visit lasts
16-22 minutes
• 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
Krista’s Story
Lemierre’s
Syndrome
External Jugular vein
Why doctors miss the story:
• Lack of training
Why doctors miss the story:
• Discomfort with patient emotions
Dan’s Story
• 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?”
• Tell your story - even after you’re
interrupted
Diagnostic Triad
Patient
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’s Story
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
Limbic Encephalitis
Diagnostic Triad
Patient
Diagnosis
Doctor
Thank you