Every Patient Tells A Story

Question 1

What kind of attitude make doctors keep interrupting patients?

Answer 1

just the facts doctor

Question 2

How often in % did doctors interrupt patients in the recorded tape?

Answer 2

75% of doctors interrupted their patients - 3/4 won’t stfu and let us talk

Question 3

What is the purpose of sander’s every patient tells a story?

Answer 3

It helps us to understand that diagnoses can be made in error - it also informs us of the art of diagnosis

Question 4

what is the best and oldest diagnostic tool?

Answer 4

the patient’s story!

Question 5

how much in percentage do patients and doctors disagree?

Answer 5

25-50% of the time, doctors and patients disagree on their diagnosis

Question 6

What is the important thing that House does that sander’s book is about?

Answer 6

House digs deep into the private lives of people - which are necessary for the best and correct diagnosis

Question 7

A Sherlockian story would go how?

Answer 7

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

Question 8

Define clinical pearls

Answer 8

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…)

Question 9

What were we doing in biopsych class when we would identify the main commissures to identify other structures?

Answer 9

we were identifying the clinical pearls

Question 10

what does sander’s believe about the language and demeanor doctors have with their patients?

Answer 10

she believes language is too cooly and impersonal, and people are forgetting that the patient is different from the disease

Question 11

What is a “hidden curriculum” in regards to the hospital?

Answer 11

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.

Question 12

_____ out of 100 cases, a physical examination changed the diagnosis completely.

Answer 12

26 out of 100 were diagnosed correctly after a physical exam.

Question 13

T or F: physical examinations do not have a critical role in making a timely diagnosis.

Answer 13

False - physical exams DO have a critical role in making timely diagnosis.

Question 14

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)

Answer 14

the doctors totally missed that his bladder was 6x the size of a normal bladder!

Question 15

what is the broad reason why sanders breaks down the physical exam?

Answer 15

she wanted to know which components of the physical exam is worth keeping and which should be tossed.

Question 16

More than ___% of the brain is devoted to sight

Answer 16

More than 50% of the brain is devoted to sight

Question 17

Besides identifying what “sick” looks like - what helps predict sickness?

Answer 17

Concrete measures such as abnormal vital signs, skin color; etc.

Question 18

what is the point of the example with sherlock holmes quote: “from close observation and deducation you can make a correct diagnosis…”

Answer 18

doctors can teach themselves to “notice what they see”

it takes astute observational skills to be able to do that

Question 19

T or F: test scores for medical diagnosis increased for students who used their observational skills and interpretation in a museum.

Answer 19

True - they believed the man in the painting took his own life

Question 20

what is the video of the gorilla passing through basketball players an example of?

why does it occur?

Answer 20

inattentional blindness - due to preoccupied attention demanding tasks

Question 21

One technique doctors use to make a diagnosis is to group: ____________, _____________, and ____________ and identify which are most important to find a pattern.

Answer 21

The technique doctors use to make a diagnosis is to group symptoms, physical exam findings, and lab data to find a pattern.

Question 22

Why do people still bring in their MRIs and X-rays to Stanley Wainapel even if he can’t see?

Answer 22

They want him to help them see what’s going on and to help them understand. That’s his job <3

Question 23

What is touch, or the doctor’s hand especially good for?

Answer 23

Touch is a powerful tool in examining breasts for cancer

Question 24

What are the 3 symptoms to rule someone out for appendicitis?

Answer 24

Alvarado’s 3 - nausea, anorexia, abdominal pain that migrates to the right lower quadrant

Question 25

What are components of the art of diagnosing?

Answer 25

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.

Question 26

T or F: I should trust the emergency room’s diagnosis

Answer 26

False - sander’s learned as a house officer to never trust the ER’s diagnosis

Question 27

What is a kappa statistic and what does it have to do with the art of diagnosing?

Answer 27

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.

Question 28

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?

Answer 28

Heart exams require hearing too - not just machines

Question 29

Who was the inventor of the stethoscope? What was he the first to discover? Why was he so revolutionary?

Answer 29

Laennec - discovered emphysema through symptoms instead of an autopsy

Question 30

T or F: In residency, physical exams are done on a regular.

Answer 30

False - residency = no physical exams

Question 31

What is an important step that doctors tend to skip?

Answer 31

the physical exam - a patient might go through many doctors, but one who does a physical exam may catch something.

Question 32

What is the benefit of doing observations of trainees and medical students?

Answer 32

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

Question 33

Over a ______ of doctors said they received no training at all before performing the procedure and they were uncomfortable with them.

Answer 33

Over a third of doctors received no training

Question 34

I’m scared, why?

Answer 34

we have doctors who have inadequate training - more than 50% of doctors go unsupervised during their firs ever procedures.