Every Patient Tells a Story Lisa Sanders M.D.

Diagnosis: Mysterious Psychosis

70-90% of diagnoses are made based on the patient’s history alone.

Diagnostic Triad Patient Diagnosis Doctor Story

Diagnostic Triad Patient Diagnosis Doctor Story

Diagnostic Triad Patient Diagnosis Doctor Story

5 doctors in 5 different practices in urban and rural England 80 patients without a diagnosis Each doctor recorded their differential diagnosis after each step of the evaluation: history, physical, test results Hampton, BMJ 1975

Correct diagnosis made after: History 68% (66/80) Physical exam 9% (7/80) Testing 9% (7/80) Hampton, BMJ 1975

4 physicians in practice is Utah 80 patients without a diagnosis Each doctor recorded their differential diagnosis after each step of the evaluation: history, physical, test results Peterson BMJ 1992

Correct diagnosis made after History 76% (61/80 ) Physical exam 12% (10/80) Testing 11% (9/80) Peterson BMJ 1992

Patients spoke for an average of 23 seconds before the physician interrupted them with a question Some physicians waited only 3 seconds before interrupting the patient

Doctors were more likely to interrupt if the patient was a woman than if it was a man Male doctors were more likely to interrupt than their female counterparts

2% of patients resume their story after being interrupted. When interviewed after a doctor patient encounter, doctors and patients did not agree on what the encounter was about Most patients had problems they didn’t get to address

Time pressure Why doctors miss the story:

The average in-office doctor visit lasts minutes

Most stories last 60 seconds and none lasted longer than 150 seconds minutes

Visits where doctors did not interrupt lasted on average 1 minute longer

Krista’s Story

Lemierre’s Syndrome External Jugular vein

Why doctors miss the story: Lack of training

Why doctors miss the story: Discomfort with patient emotions

Dan’s Story

55% of patients surveyed said that their greatest concern after seeing a doctor was a misdiagnosis

Up to 15% of diagnoses made in primary care specialties will be wrong

“An estimated 40,000-80,000 hospital deaths result from misdiagnoses annually.” Newman-Toker, JAMA, 2009

Ask your doctor: “What else could this be if it’s not that?”

Tell your story - even after you’re interrupted

Diagnostic Triad Patient Diagnosis Doctor Story

Between 2-3% of patient leave the hospital AMA (Against Medical Advice)

25-50% of patients do not take their medications as prescribed

Andy’s Story

Andy: Linds, something's wrong Lindsay: what do you mean? Andy: my memory is all f'ed up Lindsay: what is wrong? Lindsay: call the DOCTOR NOW! tell them it is an emergency. Lindsay: How is it all f'ed up? Andy: short term, i can't remember anything

Limbic Encephalitis

Diagnostic Triad Patient Diagnosis Doctor Story

Thank you