Every Patient Tells A Story Flashcards
What kind of attitude make doctors keep interrupting patients?
just the facts doctor
How often in % did doctors interrupt patients in the recorded tape?
75% of doctors interrupted their patients - 3/4 won’t stfu and let us talk
What is the purpose of sander’s every patient tells a story?
It helps us to understand that diagnoses can be made in error - it also informs us of the art of diagnosis
what is the best and oldest diagnostic tool?
the patient’s story!
how much in percentage do patients and doctors disagree?
25-50% of the time, doctors and patients disagree on their diagnosis
What is the important thing that House does that sander’s book is about?
House digs deep into the private lives of people - which are necessary for the best and correct diagnosis
A Sherlockian story would go how?
Sherlockian story or profess would be where a doctor builds up a story about the patient in order to make a diagnosis without all the particular details - they build a structure
Define clinical pearls
Clinical pearls are when doctors use observations and aphorisms containing nuggets of information when thinking about a disease
(ex: alphorism such as the five Fs of gallbladder disease - female, forty, fat, fertile, fair…)
What were we doing in biopsych class when we would identify the main commissures to identify other structures?
we were identifying the clinical pearls
what does sander’s believe about the language and demeanor doctors have with their patients?
she believes language is too cooly and impersonal, and people are forgetting that the patient is different from the disease
What is a “hidden curriculum” in regards to the hospital?
hidden curriculums are values and and beliefs of medicine as its practiced - thus everyone in the hospital basically thinks there’s NO value in physical exams.
_____ out of 100 cases, a physical examination changed the diagnosis completely.
26 out of 100 were diagnosed correctly after a physical exam.
T or F: physical examinations do not have a critical role in making a timely diagnosis.
False - physical exams DO have a critical role in making timely diagnosis.
what did doctors miss with Charlie’s x-ray? (he was the man who had a stroke earlier that week but his heart rate dropped into the 20s)
the doctors totally missed that his bladder was 6x the size of a normal bladder!
what is the broad reason why sanders breaks down the physical exam?
she wanted to know which components of the physical exam is worth keeping and which should be tossed.
More than ___% of the brain is devoted to sight
More than 50% of the brain is devoted to sight
Besides identifying what “sick” looks like - what helps predict sickness?
Concrete measures such as abnormal vital signs, skin color; etc.
what is the point of the example with sherlock holmes quote: “from close observation and deducation you can make a correct diagnosis…”
doctors can teach themselves to “notice what they see”
it takes astute observational skills to be able to do that
T or F: test scores for medical diagnosis increased for students who used their observational skills and interpretation in a museum.
True - they believed the man in the painting took his own life
what is the video of the gorilla passing through basketball players an example of?
why does it occur?
inattentional blindness - due to preoccupied attention demanding tasks
One technique doctors use to make a diagnosis is to group: ____________, _____________, and ____________ and identify which are most important to find a pattern.
The technique doctors use to make a diagnosis is to group symptoms, physical exam findings, and lab data to find a pattern.
Why do people still bring in their MRIs and X-rays to Stanley Wainapel even if he can’t see?
They want him to help them see what’s going on and to help them understand. That’s his job <3
What is touch, or the doctor’s hand especially good for?
Touch is a powerful tool in examining breasts for cancer
What are the 3 symptoms to rule someone out for appendicitis?
Alvarado’s 3 - nausea, anorexia, abdominal pain that migrates to the right lower quadrant
What are components of the art of diagnosing?
physical exams can be important because it allows physicians to actually hear what’s going on while examining the physical components
same can be true to technologies.
T or F: I should trust the emergency room’s diagnosis
False - sander’s learned as a house officer to never trust the ER’s diagnosis
What is a kappa statistic and what does it have to do with the art of diagnosing?
the kappa statistic is when doctors disagree with one another - radiologists kappa stat is 48, so that means two radiologists will disagree some of the time.
Which exam does Mangione believe should be restored in order to go back to its good old days with highly skillful and well-trained physicians?
Heart exams require hearing too - not just machines
Who was the inventor of the stethoscope? What was he the first to discover? Why was he so revolutionary?
Laennec - discovered emphysema through symptoms instead of an autopsy
T or F: In residency, physical exams are done on a regular.
False - residency = no physical exams
What is an important step that doctors tend to skip?
the physical exam - a patient might go through many doctors, but one who does a physical exam may catch something.
What is the benefit of doing observations of trainees and medical students?
Direct observations are necessary to evaluate the trainee’s ability to:
take a complete history
perform an accurate and thorough exam
communicate effectively
interpersonal and professional behavior
Over a ______ of doctors said they received no training at all before performing the procedure and they were uncomfortable with them.
Over a third of doctors received no training
I’m scared, why?
we have doctors who have inadequate training - more than 50% of doctors go unsupervised during their firs ever procedures.
