When Doctors Don’t Know What’s Wrong

A DOCTOR’S BIASES

Just which of the above approaches a doctor will take when confronted with symptoms he or she can’t figure out is determined both by his or her biases and life-condition—and all doctors struggle with both. To obtain the best performance from your doctor, your objective is to get him or her into a high a life-condition and as free from the influences of his or her biases (good and bad) as possible.

Negative influences on a doctor’s life-condition include all the things that negatively influence yours, as well as the following things that may happen to them on a daily basis:

1. They fall behind in clinic. Your doctor may be naturally slow or frequently have to spend extra time with patients who are especially ill or emotionally upset.

2. They have to deal with difficult or demanding patients. Hard not to enter into a defensive, paternalistic posture when too many of these types of patients show up on your schedule.

3. They feel like they don’t have enough time to do a good job. With fewer and fewer resources, doctors are being asked (like everyone) to do more and more.

4. They have to deal with a morass of paperwork in a hopelessly inefficient health care system. The amount of time most doctors must spend justifying their decisions to third-party insurance carriers is growing at an alarming rate.

A sampling of unconscious biases that influence doctor behavior include:

1. Not wanting to diagnose bad illnesses in their patients. Leading sometimes to an incomplete list of differential diagnoses.

2. Not wanting to induce anxiety in their patients. Leading sometimes to insufficient explanations of their thought processes, which often paradoxically leads to more patient anxiety.

3. Over-relying on evidence-based medicine. Though the practice of evidence-based medicine should be the standard, many physicians forget there’s a great difference between “no evidence existing in the medical literature to link symptom X with disease Y” and “no evidence existing to link symptom X with disease Y because it’s not yet been studied.”

4. Not liking their patient. Leading to impatience, not listening, and not taking enough time to think though the patient’s complaints.

5. Liking their patient too much. Leading to biases #1 and #2.

6. Thinking a patient’s symptoms are caused by one diagnosis instead of many. Also known as Ockham’s razor, sometimes it’s true and sometimes it isn’t.

7. Wanting to be right more than wanting their patient to get better. Res ipse loquitur (the thing speaks for itself).

8. Believing their first thoughts about the diagnosis are more likely to be correct than any subsequent thoughts. If your doctor is too attached to a diagnosis simply because it’s the one he or she thought of first, or has seen it more than other, less common diagnoses, he or she may avoid pursuing other possibilities.

9. Failing to consider that a test result may be in error. This doesn’t happen commonly, but it certainly does happen.