13 November 2010

The other side of the story

One of the biggest problems Dr Grumble comes across in his clinical work is blinkered thinking. These days lots of elderly people are admitted and sometimes, more often than not even, it is not very clear what has been the cause of their fall or whatever it was that led to their being brought to hospital. Managing uncertainty is an important part of being a doctor. Neither patients nor their relatives like uncertainty. It makes them feel uncomfortable. They are uncomfortable with not knowing. They are uncomfortable with a doctor who admits he doesn't know.

Even the system we now work in is uncomfortable with uncertainty. There are no protocols to follow for the patient with no diagnosis. These days everybody is told to follow the policy. Pneumonia has to be treated with antibiotic X or Y and a urinary tract infection with antibiotic Z or W. The reality is that, especially in the elderly, it is often not entirely clear whether the problem is in the chest or the urinary system or something else altogether. But these days a single diagnosis is made rather than the traditional and necessary differential diagnosis. And once a diagnosis is made and the protocol is followed the blinkers are put on. Sometimes Dr Grumble's juniors seem puzzled by his worrying about what the patient hasn't got. He has deliberately taken his blinkers off. Everybody else seems fixated on the label that has been put on the patient. Failing to take the blinkers off is a cause of medical errors. Doctors should always keep their minds open. Otherwise mistakes will happen.

It is in this vein that Dr Grumble, who was once described in one of our former colonies as a 'socialist blogger', provides a link to a deceptively convincing video. Do watch it. Some very important points are made. But don't get blinkered by it.

3 comments:

BenefitScroungingScum said...

That's a fascinating perspective, thanks Dr G. I have one main criteria when deciding whether I can trust and work with a doctor, their ability to admit they don't know everything. If they can't do that, I will go without until I can find a doctor who can.
BG

Dr Grumble said...

Yes. But if you were the relative of somebody at death's door and the doctors said they didn't know what the problem was you might not be so comfortable.

Things are easier to deal with once you are reasonably certain what the problem is. Recently airliners have been grounded because of an engine problem. If you don't know what the problem is you have more of a problem than if you can identify the defect. With mechanical things it can be easier - http://toronto.ctv.ca/servlet/an/local/CTVNews/20101112/airbus-rolls-royce-101112/20101112/?hub=TorontoNewHome
- though there is another airliner example in the news at present which has not been so simple and leaves everybody feeling uneasy.
http://avherald.com/h?article=4331c079&opt=0

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