tag:blogger.com,1999:blog-6397704.post5137904997807963181..comments2023-09-15T23:14:27.387+08:00Comments on .PARALLEL UNIVERSES.: How Doctors Should ThinkDr. Emerhttp://www.blogger.com/profile/02407128557937763280noreply@blogger.comBlogger14125tag:blogger.com,1999:blog-6397704.post-46137729583292035832007-09-25T23:37:00.000+08:002007-09-25T23:37:00.000+08:00Reading these blogs I had the thought that Emer o...Reading these blogs I had the thought that Emer or Groopman could probably write a nice book (like Oliver Sacks, MD) about the art and science of differential diagnoses. <BR/><BR/>Emer's approach sounds much like one of my favorite creativity books, "De Bono's Thinking Course".<BR/><BR/>Pharma Guy in NYCAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-6397704.post-30930473300742548262007-09-13T04:20:00.000+08:002007-09-13T04:20:00.000+08:00that was a very interesting story above...let me s...that was a very interesting story above...<BR/><BR/>let me say though that i do not believe the said physician made a mistake...like what you said...he took a good history and did his physical examination and found it to be normal...<BR/><BR/>most headaches are NOT a prodrome to strokes and Dr. Emer should know that...if it sounds like a horse and talks like a horse it must be a horse...sometimes it may be a zebra but good doctors don't look for zebras right away...the more common things are the more common diagnoses...<BR/><BR/>a physicians role is to get information from the patient regarding a certain complaint...do a "decent" physical examination...make a tentative diagnoses and then make the appropriate recommendations...<BR/><BR/>a headache in an otherwise healthy individual with no specifice abnormal findings is unlikely to be a stroke...i do not think treating it as a "plain" headache with NSAIDS was wrong or improper practice of medicine...it is unfortunate that he had a stroke a few hours after...very unfortunate indeed...<BR/><BR/>may i ask Dr. Emer...what would you have expected to find in the physical examination that would make you think this was a prodrome to a stroke? a carotid bruit? an irregular heart rate? an abnormal funduscopy? i doubt that there would be any neurologic findings at that time...<BR/><BR/>would you have ordered a CT scan of the head? would you have ordered a doppler ultrasound of the carotids? an ECG? even if you did...i doubt that it would have shown anything at that time considering the examination was normal...i hate to criticize other doctors practice of medicine...and in as much as there are a few doctors who are "quacks" so to say...i believe majority are good ones...<BR/><BR/>the case discussed above was NOT a mistake...it maybe a misdiagnoses...but NOT a mistake...<BR/><BR/>Very sincerely,<BR/><BR/>An Internist Practicing in Rural AmericaAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-6397704.post-27318073687187225812007-03-24T01:47:00.000+08:002007-03-24T01:47:00.000+08:00Dr. Emer, that was an excellent post. I just today...Dr. Emer, that was an excellent post. I just today made an appointment to see a new primary care, and I was very ... nervous ... about doing so. This post affirmed my reasons ... and reasoning. Thank you.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-6397704.post-7671002929480936102007-03-22T04:28:00.000+08:002007-03-22T04:28:00.000+08:00BAYI: I knew it was you!MEC: I think that's not be...BAYI: I knew it was you!<BR/><BR/>MEC: I think that's not being blinded by stereotypes anymore, like what Dr. Groopman has suggested. I think what you described there is called <B>negligence</B>.<BR/><BR/>CHRISTINE: I think that's a welcome development, should it happen. As doctors, I think we do need that added advice on how to think better to better help our patients.Dr. Emerhttps://www.blogger.com/profile/02407128557937763280noreply@blogger.comtag:blogger.com,1999:blog-6397704.post-31977483608968346172007-03-21T19:10:00.000+08:002007-03-21T19:10:00.000+08:00One of the things Groopman told me when I intervie...One of the things Groopman told me when I interviewed him is that he's trying to get a national conversation started in the U.S. about these issues--and to get medical schools to do more training in "how to think" and "how to be open to patients' questions."<BR/><BR/>Sounds like this is something that should happen worldwide.Christine Gormanhttps://www.blogger.com/profile/02031314317405641083noreply@blogger.comtag:blogger.com,1999:blog-6397704.post-64853767562393125922007-03-21T08:48:00.000+08:002007-03-21T08:48:00.000+08:00hay... this takes me yet again back to Py and his ...hay... this takes me yet again back to Py and his pedia... she saw him every month for more than 2 years and didn't think that his lopsided chest meant anything... and she missed hearing that his right lung wasn't working right... and even when Py was hard of breathing, she insisted that he was ok...<BR/><BR/>she only gave in to an x-ray because my cousin insisted our nephew might have asthma... <BR/><BR/>(it may be wrong to think ill of someone but heaven help me, I really pray God will punish her in unimaginable ways)<BR/><BR/>sigh.<BR/><BR/>anyway, Doc, your post reminded me of the series Dr. House...i know it's not a medically-correct series but they do a lot of treating each case as unique... and I sure hope that there could be some training for our doctors to be more competent :)Mechttps://www.blogger.com/profile/02655153874550285916noreply@blogger.comtag:blogger.com,1999:blog-6397704.post-56096637631351869072007-03-21T05:53:00.000+08:002007-03-21T05:53:00.000+08:00My apologies, Dr Emer. That was me. I remember cli...My apologies, Dr Emer. That was me. I remember clicking in the appropriate place and keying in my name but my computer acts funny these days. But I can't hide from you, can I? *LOL*Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-6397704.post-27761868386755744342007-03-21T02:38:00.000+08:002007-03-21T02:38:00.000+08:00WATSON: More dedication to the profession should m...WATSON: More dedication to the profession should mean being more investigative with each patient case.<BR/><BR/>ANONYMOUS: Is this you, Bayi? It would be great to live in an ideal world populated by ideal doctors and ideal patients. Yes, I have seen the same experience that happened to your mother many times, often in government hospitals here. <BR/><BR/>CHAR: Interesting read! Thanks. I might post something about that in the future.Dr. Emerhttps://www.blogger.com/profile/02407128557937763280noreply@blogger.comtag:blogger.com,1999:blog-6397704.post-92170333948216532002007-03-20T23:16:00.000+08:002007-03-20T23:16:00.000+08:00Related reading for you: http://www.expresshealthc...Related reading for you: <BR/>http://www.expresshealthcaremgmt.com/20050515/hospitalarchitecture01.shtmlCharhttps://www.blogger.com/profile/08941460541119344843noreply@blogger.comtag:blogger.com,1999:blog-6397704.post-67321706004685571572007-03-20T22:50:00.000+08:002007-03-20T22:50:00.000+08:00Personally I find Christine Gorman's suggestion ve...Personally I find Christine Gorman's suggestion very interesting and Dr Emer's response to her suggestion even more apt. I recalled an instance when my uneducated mother visited a doctor because she was worried sick about a constant headache. I took her to this specialist who after examining her, told her that there was nothing to worry about and that the headache would eventually go away. My mother was so worried that she asked if it could be something serious. The doctor took offence and rebuked her with a sharp retort, "Now, who's the doctor? You or me?" I was so embarrassed that I told the doctor off.<BR/><BR/>Indeed, I would expect not too many doctors humble or sensitive enough to accept the patient's concern (Dr Emer being an exception, of course!).<BR/><BR/>Personally I make it a point to visit doctors who listen to me while I try to describe my symptoms and the circumstances leading to my sick condition. The doctor can ask questions to probe further and I would be more than happy to answer to the best of my ability.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-6397704.post-85552463360689922482007-03-20T20:09:00.000+08:002007-03-20T20:09:00.000+08:00I think this post shows that doctors are humans to...I think this post shows that doctors are humans too, and that they are prone to emotions like the rest of us (example: joy at seeing an old friend). This can have an adverse effect though... which makes dedication a real commitment in the medical profession.Nick Ballesteroshttps://www.blogger.com/profile/11851406139825729546noreply@blogger.comtag:blogger.com,1999:blog-6397704.post-73515001665459079252007-03-20T15:22:00.000+08:002007-03-20T15:22:00.000+08:00RJAY: Thanks and welcome to my blog.CHRISTINE: Tha...RJAY: Thanks and welcome to my blog.<BR/><BR/>CHRISTINE: That's an interesting solution --- letting patients help. The only problem I see there is if most doctors would be humble enough to be helped. In the local scene, for example, majority of patients are passive followers to their "all-knowing doctors." Seldom would patients ask questions, and seldom would their doctors feel open to be challenged in difficult cases. But I agree with Dr. Groopman. Healing is a 2-way process. Patient and doctor should help each other. Thanks for the comments and the visit.Dr. Emerhttps://www.blogger.com/profile/02407128557937763280noreply@blogger.comtag:blogger.com,1999:blog-6397704.post-61680854934985555292007-03-20T10:57:00.000+08:002007-03-20T10:57:00.000+08:00What I find particularly striking is Groopman's be...What I find particularly striking is Groopman's belief that we can and should help our doctors avoid such thinking errors by asking certain open-ended questions, such as "What else could it be?"Christine Gormanhttps://www.blogger.com/profile/02031314317405641083noreply@blogger.comtag:blogger.com,1999:blog-6397704.post-59849596568964113122007-03-20T09:01:00.000+08:002007-03-20T09:01:00.000+08:00This is a very nice post. More Power Dr. Emer!This is a very nice post. More Power Dr. Emer!Rjayhttps://www.blogger.com/profile/15781490482416638227noreply@blogger.com