Doctors are not infallible – although a small minority act as if they are.
There are a number of things to consider when a patient sits before you, and at times – and even once is too often – the doctor can get it wrong.
You often hear of patients feeling like their symptoms were ‘dismissed’. Is it a lack of time, lack of experience or something more – a lack of knowledge about the patient in front of them?
The fact is, no one knows your body and health as well as you do. And as the stories published by the Mail demonstrate, as patients it’s important to trust your instincts. In fact, that’s something I’ve long urged my patients to do when it comes to decisions about investigating health symptoms.
After all, it’s something doctors themselves rely on.
Research has shown that when diagnosing serious infections in children, a GP feeling that there is something wrong is the best predictor above everything, including clinical signs and symptoms.
Clearly, medical knowledge and experience are part of the development of such intuition – we are not born with special sight, it is something we acquire.
In the same way, our patients have knowledge and experience of their own bodies, and their sense of intuition that something is amiss must be taken into account.
Sarah de Costobadie, 57, spent half a century waiting for treatment for cervical dystonia. Clair Kennedy, 46, spent a year trying to get a diagnosis for her lower back pain. She actually had lung cancer that had spread to her spine
Of course, this doesn’t mean that because they’ve Googled it, they’re correct in their diagnosis. But I think it’s important not to ignore someone’s gut feeling.
A patient, who was in a good state of health, recently consulted me about a cancer screening as both his sister mother had died of pancreatic cancer.
However, as we are all too aware, there is no simple safe screening technique for this deadly disease.
So he and I agreed that he should have a CT scan of his abdomen. To be honest, many doctors would probably not agree to doing this, not least because the technology exposes the patient to radiation, so it’s not something we can regularly repeat.
His scan showed a normal healthy pancreas, but a tumour in his right kidney, at an early stage was identified and has since been proven to be cancer.
It was his instinct that has saved him. Often ‘instinct’ is why patients seek a second opinion. Personally, I am never offended if this happens – though it’s less common as a GP than as a specialist. Don’t hesitate to ask – we should not only allow it but even encourage it.
In my opinion, a second opinion always adds something – rarely a completely different diagnosis but quite frequently something additional going on in the background.
Trusting your instinct is not straightforward. I am thinking of people’s instinct to ‘forego’ a treatment because they ‘know better’.
Another patient, suffering with chest pain, was advised by her cardiologist to undergo a stress test – where the heart is made to speed up (by walking on a treadmill, or via the injection of a drug, adenosine), with the heart’s electrical activity monitored throughout.
A distant relative – not a doctor – told the patient that she did not approve of stress tests (there was no valid reason) and that instead she knew of someone involved in heart research who had another suggestion.
The patient cancelled her investigations on the basis of that advice – which might imperil her outcome, potentially even fatally.
As a doctor, being able to encourage patients to listen to their instincts relies on trust and confidence that you know them well. This means having the continuity of care that has long been so important but which, in recent times, has been sacrificed as care has come under such strains.
Continuity of care also means we can distinguish between hypochondria driven by anxiety and genuine ill health.
It comes down to the human touch, one of the precious foundation stones of good medical care.
I fear that as we delve deeper into the world of information and computer-generated so-called intelligence, we may not solve the problem of misdiagnosis.
Humans are square pegs that don’t fit in round holes. Diagnosis is not just about statistics and algorithms but looking at the human in front of you. And, yes, trusting your instincts as a doctor, too.
