“Diagnosis Momentum” At Work?

Alas, there goes my chance to be the Cal Ripkin of bloggers. Yesterday, I got  so wrapped up in shaping a radio commentary out of Thursday’s entry that I just forgot to do a Friday entry, snapping the streak at nine. Wally Pipp’s job is safe.

So let’s play two today. (Non-baseball fans, I apologize for stuffing 3 BB references into this short entry; no more today, I swear.)

Housekeeping Details: Some days back, I wrote about an ominous tooth pain that was throbbin’ and robbin’ my  attention span. There I was, pain pills ready, all set with a Monday morning date for a dreaded root canal, and–I woke up Saturday AM  and the pain was gone. It hasn’t come back in a week.

Which makes me go hmmm on this: What if they just missed the diagnosis? The exam did seem awfully fast, it was the day before a long holiday. . . so, okay, he hurts; send him for a $1200 root canal. How often, I wonder, do doctors and dentists rush to judgment like this? How often do they start with a hunch that hardens into a diagnosis without proper examination and tests?

 Well–as I slip away from the merely personal, as promised–pretty often, according to physician and author Jerome Groopman in his new book, How Doctors Think:

 How Doctors Think is mostly about how these doctors get it right, and about why they sometimes get it wrong: “[m]ost errors are mistakes in thinking. And part of what causes these cognitive errors is our inner feelings, feelings we do not readily admit to and often don’t realize.” Attribution errors happen when a doctor’s diagnostic cogitations are shaped by a particular stereotype. It can be negative: when five doctors fail to diagnose an endocrinologic tumor causing peculiar symptoms in “a persistently complaining, melodramatic menopausal woman who quite accurately describes herself as kooky.” But positive feelings also get in the way; an emergency room doctor misses unstable angina in a forest ranger because “the ranger’s physique and chiseled features reminded him of a young Clint Eastwood—all strong associations with health and vigor.” Other errors occur when a patient is irreversibly classified with a particular syndrome: “diagnosis momentum, like a boulder rolling down a mountain, gains enough force to crush anything in its way.”

Serious stuff.


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