Every Patient Tells a Story
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Every Patient Tells a Story Lisa Sanders M.D.
description
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. - PowerPoint PPT Presentation
Transcript of 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
Story
Diagnostic Triad
Patient
Diagnosis DoctorStory
Diagnostic Triad
Patient
Diagnosis Doctor
Story
• 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
• Time pressure
Why doctors miss the story:
• 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
Story
• 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
Story
Thank you
