How doctors think

Today I had my regular follow up appointment with my cardiologist. I’ve been feeling great, so I expected a quick visit. The problem was that I went there on crutches. Last night I was weeding the flower beds and I must have done too much because this morning I woke up and my knee was very painful and swollen. The whole thing reminded me of what happened to me a few month ago—hemarthosis in my left knee, when it filled up with blood.

After I explained what had happened to me back in February, while it was not his area of expertise, he wanted to look at it. With no prompting from me, he offered to call the orthopedic practice that I use. So he did. I waited a while till the ortho guy called back. Then I carefully eavesdropped on their conversation from across the hall.

I was amazed as my cardio guy described my history and present condition precisely as I had relayed it to him. I thought, wow, this guy really listens. He stripped out the bits of my story that were not fact based (i.e. my feeling that the ER doctor should have admitted me earlier) but still conveyed the urgency of the situation and the problems I had had earlier.

Long story longer, I go to the ER tomorrow (Saturday morning) to meet the ortho guy for his assessment. He will drain it if he feels it’s necessary.

How cool is that? What service.

Interestingly enough, I just finished “How Doctors Think” by Jerome Groopman. Groopman describes different decision making procedures that doctors might use. There are what he calls algorithms that some physicians follow: If this is true, then go here; if the answer is no, go here—and on and on, following a decision tree till they arrive at a diagnosis.

This is not a bad thing necessarily, but sometimes you need out of the box thinking, especially with patients who have been suffering for years and having doctors tell them there’s nothing wrong with them.

Other times, the affection that doctors have for their patients may cause them to forego a painful test that would help a patient. They may dislike a person and that could color their judgment.

Acknowledging uncertainly is OK, too, though scary for everyone.

He ended the book talking about “patient as partner”—a nifty concept that I like. I am still learning how to do that. Every time something happens to me, I learn more. This is a heck of way to do it, but we learn from experience. For instance, I am now an expert of sorts on hemarthrosis, mitral valve replacement, pacemakers and open heart surgery—as they apply to me. There are so many things that can go wrong with your heart, I no longer pretend to know what your problem is like, because you are not me.

So, let’s see what happens tomorrow.