Medical Expectations.
“They didn’t do anything!”
Are your Medical Expectations – misconception or unrealistic? Many patients do not understand the thought process of medicine.
Recently a patient came into the clinic. The patient had been to four different emergency rooms/clinics. She stated that no one had done anything for her. Her complaint was chronic recurrent abdominal pain. A review of the medical records from previous institutions demonstrated she had had multiple tests, including blood tests, Cat scans (CTs), and magnetic resonance imaging (MRIs). All tests were within normal limits. Multiple complete workups had been done, but her misconception was they had not done anything. Her expectations were that they would cure her.
Medicine is an art within science. There is no black and white. Many symptoms can be found in a multitude of diseases. For example, a sore throat can be caused by at least 15 different causative categories. So like detective investigations, there is a process we follow.
Not everybody with a headache has a tumor or a brain bleed. We use differential diagnosis with data gathered from symptoms, history, review of symptoms, physical exams, and tests to help decipher the disease or illness.
A differential diagnosis is a starting point. Using the data, we look at all the possible causes. First, we eliminate the red flag diagnosis. Red flag diagnoses are those diagnoses that would cause irreparable or severe harm to the patient if missed. An example, multiple problems can cause chest pain. We would not want to miss a heart attack, pulmonary emboli, or collapsed lung.
Once red flags are discounted, we proceed to treat the most common causes and rule out others. However, not all diseases are clear-cut, and all conditions do not have specific tests.
The primary stepping stone in diagnosis is history. History helps us to eliminate or proceed down a specific path. Over the next several months, we discuss the importance of a clear history, review of symptoms, physical exam, and test.
