As promised…
We bring you our first attempt at “stump the chumps”. This is where we are presented with a challenging diagnostic case and we think out loud as we reason our way through it. You can play along as you hear the case unfold.
Once you’ve listened you can learn more about the disease process discussed by reading this excellent review article.
And as always you can leave us feedback and suggestions by clicking on the Leave a Comment link on the upper-left menu.
Thanks a lot
Hi there,I check your blogs named “Episode 5: Stump the Chumps – IMreasoning” on a regular basis.Your story-telling style is witty, keep it up! And you can look our website about proxy server list.
Really enjoyed this – keep them coming please!
Few comments- First, in my hazy memory we won 3-2. OK so it was not a masterpiece but who knew we were facing the finest hitting catcher since Carleton Fisk. You know that joke about the car mechanic and the surgeon? The mechanic says, “when a customer comes in, I, like you, obtain the history, think about the possibilities, run some diagnostics to test my hypotheses and then fix the culprit problem. Why do you make so much more money?” The surgeon says, “yeah but can you do that with the engine running?!” In Dr Dhaliwal’s grand rounds I found… Read more »
Well Eugene you could go home and watch old echocardiograms or you could come to New Zealand where it has been ten years since I filled out an insurance form or a disability form.
Your belief that your team won 3-2 represents a well-known cognitive error called CREATIVE MEMORY where the pain of a past event leads one to reframe that event in less painful, even hopeful terms…
These interesting discussions have reminded me not to acquire any condition that is difficult to diagnose. I am going to stick to the easy stuff, increasing the likelihood of my doc(s) getting it right without challenging their cognitive processes. I also not that patients are not able to tell how good a diagnostician they have until perhaps after it is learned that they got it wrong. Maybe we need every doctor’s office to have a posted grade for their last x months of diagnoses, possibly weighted for how hard those diagnoses were to make. Something like posted restaurant grades here… Read more »
William, not a bad idea to have a some sort of diagnostic accuracy index for each doctor… But this is precisely the kind of feedback tool that no one has been able to develop to date. It is harder than you might think.
Hi Art! Are there other factors in not getting a CT scan right away such as resource limitations related to the health care system down there?
Its very sweet that you are all coming to Art’s defense… for what its worth, here in Auckland, CT scans are almost easier to get than a CXR!
More seriously, what is the line between bias and experience, as it is between profiling and stacking the odds. Should we not base our judgment on our past experiences? Art’s gastritis diagnosis will probably be right 9.5 out of 10 times. Efficiency, and therefore access to YOU, is important too.
Very good points. Maybe the idea is to be aware. Intuition IS going to be correct 95% of the time, in the hands (brains) of experienced clinicians. Art was beating himself up over his case because he wasn’t even aware that he strictly used intuition, and he never used a cognitive checklist. “sounds and smells like gastritis…could it be something else?…maybe, but no red flags so will stick with gastritis”. Right or wrong, and with no difference to the outcome, that self-talk may be a better error that to not think of it at all…
And in fact Gene and Nic, there WERE red flags, plenty of them, in my case of gastritis. Sudden onset of severe pain, pain requiring morphine. Those things SHOULD have been red flags but weren’t because I had closed my diagnostic mind to other possibilities. I agree that the expert clinician (and I don’t include myself in this category!) will be ‘right’ most of the time but a quick cognitive check can decrease the risk of being wrong, even for the expert and doesn’t take that much more time.
Art
Art, I hate to break it to you, but you are definitely considered an expert clinician. I know its all relative, but on the “all-comers” scale, you’re at the top of the heap.
When Roger Goodell agreed with himself about Brady’s suspension, was that bias? Seriously love the conversations on your podcasts. Keep ’em coming.