
You Will See the Doctor’s Fallibility Now - danso
http://well.blogs.nytimes.com/2015/08/10/you-will-see-the-doctors-fallibility-now/
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TallGuyShort
I'm also a little disturbed by the x-ray technician. Are patients really so
full of shit that often that it's normal to ignore what the patient says is
obviously the wrong foot? I had a similar experience when my work required I
have a very thorough medical examination including a Tuberculosis test. I was
pumped full of massive amounts of the vaccine as a kid because I grew up in a
third-world country, so the skin test would give a false positive. I told the
doctor, they asked if I had ever had a positive result, and I said no because
they always go straight to the chest x-ray. So they insisted I do a skin test
first. My elbow swelled up like crazy, the nurse and the doctor freaked out
and sent me to an infectious disease specialist. The freaking specialist still
didn't want to see my vaccine records - she said I should have a chest x-ray
and start strong antibiotics immediately. Chest x-ray came back clean.
"Mysteriously", as the doctor said, I did not in fact have tuberculosis. It
was like they were all deaf while I was explaining how many times I had been
vaccinated, so OF COURSE it shouldn't have been a surprise that my blood was
still loaded with anti-bodies.

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fossuser
I think you see similar situations in tech with users/support. If you
routinely deal with users who have no idea what they're doing you start to
discount what they're saying.

Granted someone who's good at troubleshooting should be able to judge the
relative understanding of the user just like a good doctor should be able to
judge the reliability of information coming from the patient.

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verisimilitude
> just like a good doctor should be able to judge the reliability of
> information coming from the patient.

Exactly! A good doctor must be able to read people well; their communication
style, presuppositions, personality, and this will help the doctor determine
if someone is exaggerating their symptoms, understating their pain, etc. etc.

Unfortunately, medical schools simply do not select for someone with this
skillset, and this is not a new problem: "For decades, the medical profession
has debated whether pre-med courses and admission tests produce doctors who
know their alkyl halides but lack the sense of mission and interpersonal
skills to become well-rounded, caring, inquisitive healers." Read more here:
[http://www.nytimes.com/2010/07/30/nyregion/30medschools.html](http://www.nytimes.com/2010/07/30/nyregion/30medschools.html)

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henrikschroder
Ha, "laterally challenged" was a new and fantastic label, I'll try to apply
that to myself whenever I get left and right wrong.

It's an interesting problem though, I have excellent sense of direction and
I'm good at 3D visualization and map reading. I don't get the directions
wrong, I get the _words_ for the directions wrong.

I can happily point the left, know we should go to the left, and say "let's go
right!"

So it's probably a very different problem from, say, people who lack sense of
direction, my problem is more like extremely narrow aphasia. I don't know of
anyone who confuses up and down in the same manner though, it's interesting
that it's just left and right, and that it's not that uncommon!

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bryondowd
Regarding up/down vs left/right. Perspective is an issue with left/right, but
generally not for up/down. Everyone in the vast majority of circumstances
share the same up/down perspective. When it comes to left/right, you often
have to do some mental acrobatics to figure out what the frame of reference
is, in order to figure out which way is left or right from that frame of
reference. It's easy to just point and say "that way", but to know whether to
say "left" or "right" you have to think, "ok, this is my left, but which way
is he facing, is that his right? ok, but if I say right, will he think I'm
saying his right or mine?"

That's why sailors invented port and starboard. Maybe we should apply this to
doctors. "Ok, we're operating on the starboard knee today!"

To be fair, I assume they use left/right from the perspective of the patient,
but I could see using a separate pair of terms being useful, the same way it's
useful to say port/starboard instead of saying left/right and an understanding
that the perspective is focused toward the bow (front) of the ship.

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pygy_
_> To be fair, I assume they use left/right from the perspective of the
patient._

That's correct. The trouble is in anatomy and hence in radiography, the
standard position is having the patient facing you. Left and right are thus
systematically inverted in medical images

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biomcgary
Statistical reasoning is far more important for deciding tests and treatment
than the ability to reliably distinguish between left and right. You can use a
marker on the skin before surgery, but statistical reasoning may determine
that surgery is not even the best option.

Unfortunately, if doctors were filtered based on their ability to do basic
statistics, we would lose 90% of them.

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crpatino
Doctors are probably better, or at least no worse, than the general population
on that account.

The problem is that "statistical reasoning" is so alien to normal de facto
human reasoning that you need years of training before it sets in. Doctors are
already taking on a completely different set of extensive training, and their
elders did fine with only the most basic statistics knowledge, so clearly
(sigh) there's no need to dig into the fancy pants version of the thing.

Epidemiologists probably know better, but how do you have them explain to the
GPs that this is a useful tool to have???

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healthenclave
This is a common problem in medicine. As some one who regularly prescribes
xray to patients (in Orthopedic Surgery) we have very strict instructions to
the radiology technicians to perform the imaging of the side that is mentioned
in the orders. Due to a variety of reasons. But we sometimes do make mistakes.

But like the author describes doing the same mistake is the OR and performing
a surgery is a disaster of several magnitudes. One of the common problem is
that many times senior consultants have limited contact with the patients and
their sole focus is doing surgeries. Usually residents and the younger docs
are involved in the preoperative care of the patient.

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mindcrime
On the topic of "Doctor Fallibility" there's a really good book that I
recommend to pretty much everybody: _How Doctors Think_ by Jerome Groopman.
There's a lot of info in there on how and why doctors make mistakes and, more
to the point, information on how you - as a patient - can avoid being the
victim of a mistake (more specifically, a mis-diagnosis) by your doctor.

The ideas in there wouldn't necessarily help with this X-ray scenario, but I
think it's wildly useful information for anybody who ever sees a doctor.

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Kenji
If you want something done right, you gotta take responsibility yourself. It's
like that everywhere, be it as simple as archiving a single sheet of paper
correctly. But especially when it's about your own body. Doctors have a
tendency to advise the patient not to do research on their own and keeping the
patient "dumb" (or calm, if you want to be more polite and less honest). This
is very bad and worsens the problem.

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emodendroket
Sure, but I mean, really. You don't have the doctor's training; you need his
help. This should really be a collaborative process, although too often it is
not.

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wehadfun
I went with my Dad for neck surgery like 5 different people asked my dad if he
was there for neck surgery. Now I understand the purpose.

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detaro
Heard of clinics where they won't do a planned operation unless the patient
(if in a state to do so), the surgeon and the anesthetist have all signed the
body part during the preparation. Makes sure all parties involved are on one
page and they actually have the right person on the table.

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stephengillie
This person should not be a doctor. Not with this "profound left-right
confusion". People with severe diabetes are not allowed to drive commercially.
People with sea sickness don't usually captain boats.

\---

Edit: Apparently I'm at my limit on my work laptop, but can read it on my
phone.

Unlike other NYTimes articles, this link takes me directly to a paywall. I
don't even get to see a blurb, abstract, teaser, or dateline. Going directly
from Google also puts me at a paywall.

~~~
ars
> This person should not be a doctor.

Maybe. But since he has such strong self awareness of the problem his is able
to self-implement protocols to correct and protect from the problem.

Just like people with controlled diabetes can drive.

A simple dot tattooed somewhere inconspicuous on the hand (make it look like a
liver spot) would be enough to solve the problem.

~~~
epochwolf
> A simple dot tattooed somewhere inconspicuous on the hand (make it look like
> a liver spot) would be enough to solve the problem.

I have the same issue as the doctor and this wouldn't help me. I know which
hand I write with. (My right). I always know which hand is my right but I
still can't tell right or left for directions. It gets flipped during
processing like dyslexia.

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Qantourisc
I'm a firm believer of marking the affected area before any procedure. It's
cheap it's simple. HOWEVER only the patient is allowed to apply the mark.

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cheald
I had knee surgery recently. Before I was given any medications, I met with my
surgeon, we verified what he was going to do, and he marked and signed the
area to be operated on with a sharpie marker.

It took less than a minute and gave me an awful lot of peace of mind that I
wouldn't be a victim of a bad memory or procedural screw-up.

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FroshKiller
This article reminds me of the scariest joke:

What do you call the guy who graduated last in his class from medical school?

Doctor.

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SilasX
I've always felt that was ho-hum, as zingers go, since the standards can be so
high that the lowest rank is still pretty good in absolute terms. It's like
saying, "You know what I call a bronze medal? Last place." Er ... a bronze
medal is still very impressive.

If you want a clever anti-doctor zinger, I'd use something like, "You know
what it's called when a really well-read expert diagnoses you wrongly on a
hunch, gets it wrong, leaves you suffering for years, and never has their work
reviewed? Medicine."

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FroshKiller
A bronze medal is third place, not last place. Twenty-five countries competed
in the luge in the 2010 Winter Olympics, and twenty-two of them went home
without medals.

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SilasX
That's my point: bronze is last _out of an unhelpfully narrow subset of the
population_ , just like "last in your class of medical school" is last out of
a well-qualified group of people to begin with.

And even if you were last at the Winter Olympics you mentioned, that's still
better than the overwhelming majority of the world, and would say very little
to establish that you're a bad athlete, as suggested by the medical school
quip.

To rephrase it in terms of your example, it would be like if I said, "What do
they call the 25th best skiier in the world? Last place [at the Olympics]."

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bane
Hold your hand up and make and L with the thumbs and forefingers of both
hands, palms facing away from you:

1) "L" is your Left hand.

2) Is the patient facing towards you? "Left" is the opposite side on them.

Two rules that will revolutionize healthcare forever.

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venomsnake
Oldest joke in med school:

Old surgeon to young one:

\- Jim, amputate the left foot.

\- Jim - the left!

\- Jim - the foot!

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k__
lol

Reminds me of a story I once heard.

"And jokingly I told the surgeon that I will mark my arm with 'THIS ARM'
before the surgery and she said 'Yes, please do this'"

