Most people pray that they remain healthy. Since we know it is unlikely we will always remain healthy, may I suggest a more practical prayer? Pray you only get common diseases.
Before a doctor can treat you, she needs to figure out what ails you. This involves the art of diagnosis, and it is an art. Misdiagnosis, either the failure to accurately diagnose an illness or the failure to reach a diagnosis at all, is one of the leading causes of injuries due to malpractice that I see in my work.
When a doctor is confronted with a sick patient, she must create a differential diagnosis, a list of the things that might be wrong with the patient in the order of their probability and lethality. A good diagnostician begins inquiring about the chief complaint of the patient. A good diagnostician is always a good listener. Why is the patient here? The doctor then moves on to a medical history of the patient. What significant illnesses has the patient had? What vaccines has the patient received? What about the patient’s family? Alive? Dead? If dead, of what did they die? Any family history of major diseases? The next step is a physical examination focused on the areas which might be involved in the patient’s chief complaint. Before or after the examination, the doctor may order laboratory tests of blood and urine or may order imaging studies. All of these may be pieces of the puzzle presented by the patient. When all is said and done, hopefully the doctor will have reached a diagnosis. The next best thing will be a differential diagnosis which can be further pursued to rule out items on it until there is only one thing remaining.
If you have a common illness and you have what medical science recognizes as classic symptoms of that disease, you are in luck from a diagnostic standpoint. The doctor should have little trouble diagnosing your problem. A 60 year-old, obese, male, smoker presenting with crushing, substernal chest pain and an abnormal EKG is likely going to be diagnosed with a heart attack. A young person presenting with acute pain in the lower right abdomen, fever and nausea is likely going to be diagnosed with appendicitis. On the other hand, if you come in with vague complaints that are not consistent and that come and go, you are at risk of being misdiagnosed and the consequences can be fatal.
So why the zebras in the picture above? When there is a case of misdiagnosis and the disease or medical problem is uncommon, the malpractice defense attorney always says the same thing by way of excusing the doctor’s mistaken diagnosis, “When a doctor hears hoofbeats, he thinks of horses, not zebras.” In other words, doctors think of common illnesses when they see symptoms that some common diseases have. They don’t usually think of rare conditions that may have many of the same symptoms, even though those rare conditions should be on the differential diagnosis along with the common diseases.
So your best bet when you get sick is to have a common condition and a classic presentation. Even doctors who are not very skilled in diagnostics will probably get it right and get you treated appropriately. Rare conditions are much more likely to be misdiagnosed and to fail to receive appropriate treatment. Watch out for doctors who jump to quick conclusions or who do not seem to be listening to you when you try to explain what is wrong. Your life may depend on it.
