We currently have a very cool consultant on our firm (or I guess the very cool consultant has us on his firm). He’s quite scary and knowledgeable, but he’s an exceptional teacher.
He uses every patient as a teaching opportunity, and of particular interest is that he does not simply accept a given diagnosis and plan according to it. He considers every symptom and sign, even for patients diagnosed with, for example, SLE several years ago, and if he does not think they were correctly diagnosed he will investigate it further.
He calls this “Physician Inertia”: When doctors blindly accept whatever is written in the patient’s file and then wonder why a patient is not improving. For example, we were struggling to understand why a patient was simply not responding to his TB medication (he was referred from a satellite clinic, from whence came the TB diagnosis).
While awaiting sensitivity results, we contacted the clinic only to be informed that the patient had been diagnosed upon clinical suspicion and not on a positive culture or even a suggestive chest X-ray. When we reviewed the CXR, it was most definitely not a TB-picture.
I guess it is worth remembering that even physicians make mistakes. Or maybe a lab result was a false-positive. Either way, the unwritten rule in medical hierarchy seems to be that you do not question a colleague’s (especially a superior’s) diagnosis… but perhaps this is costing us.
So now when we see a patient for the first time, we are told not to look at their file until we have taken a history and physical with uninfluenced minds. It helps a lot. I don’t think many doctors would like having their diagnoses questioned, but this doctor is teaching us a lot through it.