motivations for the right dx

Kuhn, Gloria gkuhn at MED.WAYNE.EDU
Wed Jan 22 15:04:43 UTC 2014

I think  "going further"  is an internal need.  with a number of "prods":  1) the self-motivated need to be correct (doctors have a lot of ego involvement which is both good and bad:  sometimes it forces us to go the next step to find the correct diagnosis and sometimes it results in anchoring, 2) the worry if you think you are not correct, 3) the fear for the patient, and 4) yes, sometimes the fear of litigation.
I have not listed them in the order of importance.
I think every doctor has woken up after a midnight shift and thought "Oh my God" I was wrong.  Or in the car ride home after finishing work.  Then there is the frantic attempt to contact the patient or the patient's doctor and the tremendous relief when you talk to the patient who is all right and tell them what you are thinking.
Glori a
From: Vic Nicholls [nichollsvi2 at GMAIL.COM]
Sent: Tuesday, January 21, 2014 7:56 PM
Subject: [IMPROVEDX] motivations for the right dx

Something I don't think we've kicked around:

what would influence doctors to go a little further for the right dx? I
have a lot of comments from the doctors side, but is it money that
entices or a pat on the back? I tried pats on teh back with some other
doctors and it backfired.

What happens with a complex/complicated patient?

On 1/21/2014 12:36 PM, Graber, Mark wrote:
> This is an important comment, and thanks Victoria for both sending the note to your physician and mentioning it on this forum.  In an ideal world, care would be both patient centered AND knowledge-based.  These goals come into conflict a lot these days - many physicians don't take the time to take advantage of decision support resources, and some believe that their patients will perceive them negatively for doing so.
> Hopefully someday we will get to the point that physicians use decision support routinely, and patients see the value in this, as you did.  The trick is to somehow maintain the patient-centered focus, and not spend so much time at the keyboard that the patient feels neglected.

Moderator: Lorri Zipperer Lorri at, Communication co-chair, Society for Improving Diagnosis in Medicine

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