When you go to see the doctor because you are sick, the first order of business is to get a diagnosis. How does the doctor arrive at that? What does she need to know? And is there any way you can help your doctors with diagnostic challenges?

Meeting Diagnostic Challenges:

Getting the right diagnosis is crucial to getting the proper treatment. For many conditions, the diagnosis is pretty straightforward. But sometimes it can be quite complicated. The doctor may need to figure out which of many different diseases is causing the problems. When symptoms are not very specific, pinning down the diagnosis is a challenge. But diagnosis can also be difficult if the symptom is very specific but unfamiliar, like a black thumb on a gardener.

Diagnostic Challenges of Psychiatric or Physiological Causes:

It can be tricky to distinguish between a physiological condition that causes psychiatric symptoms and a psychiatric disorder that causes real physical symptoms. Find out how to get a truly independent second opinion, and why you should keep your primary care provider in the loop. When is it helpful to search the internet, and when might that be useless?

Here are some lists from our book, Top Screwups Doctors Make and How to Avoid Them.

Top Ten Reasons for Diagnostic Errors:

  • Overconfidence
  • Information overload
  • Going it alone
  • Tunnel vision
  • Time pressure
  • Missing test results
  • Ignoring drug side effects
  • Follow-up failure
  • Hurried hand-offs
  • Communication breakdown

Top 10 Questions to Ask to Reduce Diagnostic Disasters:

  • What are my primary concerns and symptoms?
  • How confident are you about this diagnosis?
  • What further tests might be helpful?
  • Will the test you are proposing change the treatment plan?
  • Are there any findings or symptoms that don't fit your diagnosis or that contradict it?
  • What else could it be?
  • Can you facilitate a second opinion?
  • When should I expect to see my test results? How will they be delivered?
  • What resources do you recommend for me to learn more about my diagnosis?
  • May I contact you by email/phone/text if my symptoms change or if I have an important question? If so, what is the contact info?

This Week’s Guest:

Lisa Sanders, MD,  is a clinician educator in the Primary Care Internal Medicine Residency Program at Yale School of Medicine. In addition to her work as a physician and teacher, she writes the popular Diagnosis column for the New York Times Magazine. Her column was the inspiration for the Fox program “House MD” (2004-2012) and she served as a technical adviser to the show.

Her books include Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis.

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