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Bet Rob's avatar

Years ago, I read a book called "How Doctors Think". I was struck by its finding of how quickly a physician makes up his mind after asking a patient "tell me why you're here." In as little as 17 or 18 seconds, the doctor has interrupted the patient, and has one or two possibilities firmly in mind. He basically tunes out anything the patient says subsequently that might change his diagnosis.

I've seen this repeatedly with both my primary physician, and the pediatrician we saw when my children were young. My doctor is wrong about half the time when he gives me a diagnosis. For example, the "reflux" he diagnosed early in my first pregnancy was more likely a gallbladder issue. He diagnosed sudden-onset knee pain 10 years later as arthritis, since an MRI supposedly showed no meniscus tear or other damage; I had an inflamed medial plica and an old, long-asymptomatic horizontal-cleavage lateral meniscus tear, easily found by the orthopod I referred myself to the next week.

When my son fell off the growth chart at 4 years old, the pediatrician insisted it was fine, variously invoking "you and your husband aren't tall" (we're average height), and "he's just a late bloomer" for 5 years, until I put my foot down and insisted on the endocrinologist referral. My son had growth hormone deficiency, and responded beautifully to GH therapy. When my son was 12 and complaining of knee pain, the pediatrician blew it off as Osgood-Schlatter's due to rapid growth, despite none of the symptoms matching. (Coincidentally also an inflamed plica, from a known injury.)

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Timothy Winey's avatar

Brilliantly insightful piece.

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