What I learnt this week: The imposition of implication #WILTW

This is the 72nd #WILTW

This week’s #WILTW could have been on many things. The challenge of visualising academic data in a new age of presentation styles, understanding what makes sense to me might not make sense to my audience and finally remembering to do simple things like pick up plastic dinosaurs before leaving the house.

What I have settled on is something that has had quite a profound effect on me. I attended the Stanford University #MedX conference last weekend. There are certainly bigger conferences in terms of participants but its digital and social media prescence has always been substantial. I must admit to having a bit of skepticism about the aims:

Medicine X is a catalyst for new ideas about the future of medicine and health care. The initiative explores how emerging technologieswill advance the practice of medicine, improve health, and empower patients to be active participants in their own care. The “X” is meant to encourage thinking beyond numbers and trends—it represents the infinite possibilities for current and future information technologies to improve health.

However I am no longer skeptical and one of the most impressive things about the conference was the patient and public prescence. And not just in the audience, on the stage as well. I spent an afternoon at #MedX listening to how social media has been utilised by patients to engage and inform others.  I have another blog on the session but I want to highlight one particular lecture by Abby Norman (@notabbynormal). The story is best told by Abby herself so I would encourage you to read her talk. In summary Abby had a delayed diagnosis of endometriosis (an all too common occurence in healthcare). She spent a great deal of time researching her own symptoms, and in the process, creating a network of fellow sufferers via social media. At one stage she quotes her surgeon:

You are either brilliant — or the most well-educated hypochondriac I’ve ever met,” he said. But he humored me. He scheduled another surgery.

It turns out she was brilliantly educated.

Abby’s story is painful to listen to. It raises many questions about the diagnostic abilities and listening skills of doctors which have been beautifully encapsulated here  (The article has bitter resonance for me as I brushed aside my wife’s abdominal pain for far too long – she also had kidney stones.)

There is a flip side to this challenge. It is difficult to explore, especially in a public setting, but it exists and influences the judgements of health care professionals throughout the world. Simply there are many patients who have chronic symptoms which do not have a physical cause. This is not saying they are any less ill or deserving of treatment just that an operation or a specific medication will not be curative. The reasons for this are multi-factorial and complex. Certainly dismissing somatisation in a patient is as bad a medical practice as failing to recognise an obvious  appendicitis. The medical management for somatisation and appendicitis are very different though. Furthermore through a quirk of human nature professionals are often too quick with their own pattern recognition of initial presenting complaints. It is easy to dismiss vague or nebulous symptoms as not being significant and quickly stereotype a patient as nervous or over anxious.

Six components of quality

On the flip side, it is not possible to investigate all patients who present for all possible diagnoses. This would not be equitable or effective use of resources (2 of the core components of quality health care.)

So how do health care professionals avoid labels and perpetuating medical mistakes? Well we listen closely, we examine thoroughly and we remain open minded. We should be aware of the implications of our decisions:

and if your decison gives the patient no safety net or no way out to review a diagnosis you must ask yourself: Is this a good decision?

What have you learnt this week? #WITLW

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