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What to Do When Your Doctor isn’t a Great Diagnostician

I have never heard anyone say that their doctors have hit it out of the park with an accurate diagnosis every time they bring a medical mystery symptom to the doc’s attention. Granted, nobody complains when things go right, so we might not have a good way to measure the number of accounts of consistently accurate diagnosis. The success story is documented in the medical record, which is protected from prying eyes. Not even God gets a pass on HIPAA privacy rules. And so, like the deity, the true shamans shall remain shrouded in cosmic mystery.

Horror stories

Sadly, a number of us have horror stories about doctors that initially seemed to be normal humans and suddenly become obtuse, accusing A-holes, curtly dismissing us as hallucinating, stressed out soup sandwiches that can’t tell the difference between hypochondria and actual illness, and how dare you waste their time with such drivel?

Yikes. They seem so sure that you’re apt to believe them. After all, they’re the experts, aren’t they? Hm.

From what I’ve experienced and heard and read in articles by and about doctors on KevinMD, it’s pretty much hit and miss with most of them. And by their own admission, their egos muck it up even more by gaslighting us into doubting our own senses. Here are some reasons why they can’t just say I don’t know what’s wrong with you but we could run some tests to rule out (insert differential diagnoses here):

Arrogance

Their arrogance won’t allow them to own the fact that they can’t possibly know everything. Okay, but where did those expectations originate? Maybe there’s a lesson to be learned for all involved. We patients need to do a reality check on our own expectations. Doctors shouldn’t be expected to possess the other-worldly diagnostic expertise of a Gregory House, MD. If we recall his techniques, he performed outrageous, illegal acts to rule out the possibilities, often bringing his hapless patients to the brink of death and poor Dr. Cuddy and Princeton-Plainsboro to the edge of ruin.

Odd details can be vital

Heuristic decision-making. They are judging your case based on the patients they saw before you who displayed the same symptoms. If 20 patients earlier in the day complained of numbness, pain and weakness in their legs along with mental confusion and fatigue just like you did, chances are they fit the model of panic attack, depression and stress, causes that are well-documented and widely treated. The success of this strategy lies in ignoring part of the information the patient is giving. It is considered an effective tool that saves time and expense. Unfortunately it does not serve the needs of those with complex neurological presentations where odd details can be vital clues on which to follow up.

Seek another opinion

What can we do about it? After we’ve gotten blown off—and still experiencing our symptoms—we need to seek another opinion, but not through our doctor’s referral. If we ask them to find one then we run the risk of our doctor’s bias extending itself to the referring physician, who is likely to be a buddy of theirs.

Some experts advise us to seek psychiatric evaluation to rule out that it’s-all-in-your-head diagnosis. While it is a legitimate option with the potential to rule out a flight of fancy, we might not all have the luxury of time to do it. If we are suffering to the extent that we can’t work or function, we need to aggressively research specialists.

Advocating for ourselves

We can consult our insurer for in-network doctors as well as friends, family members and co-workers. If we suspect MS, we can request a list of specialists from MS organizations. It is time-consuming, but advocating for ourselves is not just a need, it is a sign of the times. Even our doctors expect us to do it. And no matter what the outcome of those referrals, we should send a copy of the notes and test results to the doctors that blew us off. It could be the epiphany that changes their attitudes and improves their care.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The MultipleSclerosis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. “Heuristic decision-making in medicine,”  by Julian N. Marewski, PhD, and  Gerd Gigerenzer, PhD, Dialogues in Clinical Neuroscience, pub. 2012 Mar; 14(1): 77-89. Source: NCBI, US National Library of Medicine, National Institutes of Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341653
  2. “What To Do When You Doubt Your Doctor: Ask questions, get clarification and consider a second opinion,” by Elizabeth Renter, Contributor. U.S. News and World Report, Health Care / For Better, 29 Sep 2015. https://health.usnews.com/health-news/patient-advice/articles/2015/09/29/what-to-do-when-you-doubt-your-doctor

Comments

  • poetgirrl
    11 months ago

    For several years, I fell often, one time resulting in serious injury. My psychiatrist, an MD,, thought the falls were a result of my body acting out my unconscious desire not to be on this earth. This went on for years until I told my internist that I’d noticed that my right side seemed much weaker than my left and she sent me for an MRI, which revealed MS. Looking back, I think there was some truth in what my psychiatrist said—it just wasn’t why I was falling down. She says that she learned from that experience and now tries to make sure that physical causes are eliminated first. My guess is that lots of psychiatrists wouldn’t be so amenable to admitting they were wrong and changing as a result.

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