Reconsidering diagnoses

Vic Nicholls nichollsvi2 at GMAIL.COM
Mon Jan 20 23:26:56 UTC 2014


1) Because the very first original physician told me that if I didn't do
as he asked, he'd basically ruin me by putting it in my records.

2) The other physicians were given the evidence, but when asked, said
they couldn't diagnose it because it wasn't in their scope of training
or experience. However they could tell me I didn't have it (but couldn't
explain why the medical research I had was wrong or what their criteria
was diagnosing the problem).

Btw, I was told to go elsewhere if you don't like us ("satisfied with
our care"), by that physician in #1 and his buddy. That seems to be
pretty standard as a response in this area, as I'm not the only one
who's had that.

and yes, I've gotten worse and things have progressed because the #1
physician wouldn't treat it and wouldn't give me the information in
early 2013, that he used to diagnose me in 2012. Expressly written in
the notes shows I stated another doc was willing to help me out but they
needed someone who had more experience, and that's why I asked the
questions.

Funny thing, I went to another new doc and gave her my medical research,
she ran the tests. The instant she saw a wrong dx in my records, she
auto assumed that I was wrong and the doc right. The funnier part of
that is that the first 2 criteria for the wrong dx, I have never met by
the standards of care nor was there any evidence or record of problems
in the original docs' notes or tests. I'll show that to her when I see
her in Feb.

I've been on enough doc lists that I'm sure you all can figure out what
is going on.

Victoria


On 1/20/2014 5:51 PM, Karen Cosby wrote:
> Why aren't you willing to tell the first physician?  Physicians can't
> learn from the experience, or come to recognize a some conditions
> unless they get feedback.  Most of us want to be correct, and we want
> feedback if we aren't.  A Big problem I see is patients switching
> doctors whenever they don't think the diagnosis is correct, rather
> than returning to the original with new evidence or new information.
>  I saw a patient this week in the ED who had been admitted to 2
> different academic teaching hospitals with extensive workups who came
> to the ED because they didn't have a diagnosis established. (And they
> came without copies of any of their tests or imaging).  Whenever
> patients switch doctors, most doctors begin all over again with the
> same point rather than build on prior work-- inevitably arriving at
> the same conclusion.  If we don't know what's been done before, we
> can't make progress beyond what's already been done.  We need to
> explain that diagnosis is an iterative process.  We typically begin to
> workup what is most dangerous, things that need to be ruled out to be
> safe, and common things.  Only after that do we consider unusual
> causes or less common or more chronic conditions.  It's not
> necessarily wrong to take time to establish the diagnosis, especially
> if it's not emergent or common.  We should all be lucky enough to
> arrive at the correct diagnosis in a single visit, as if endowed by
> some special power.  Instead, we sometimes have to plod along
> hopefully with some thoughtful and considered process.  Part of the
> problem isn't always that doctors don't try or aren't informed; some
> of this is a failure to establish trust and communicate the process
> necessary to make a diagnosis.







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