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When the error was discovered, the hospital administration immediately launched an inquiry. There had been an administrative mix-up in handling the results of the needle biopsy of Linda’s breast lump. However, when the pathologist examines Linda’s excised breast tissue, he can find no signs of cancer. After some discussion of the options, however, both accept their doctor’s counsel that surgery is best. Both are shaken by the news, and both silently dread surgery. Linda is 58 and healthy Susan is 78 and has heart failure. To see why, let’s consider two women, Linda and Susan. It is difficult for doctors to be sure, however, because a preference misdiagnosis generally goes unnoticed. Many doctors believe that they already incorporate patient preferences into their treatment recommendations. It allows doctors to believe that they are the experts who make decisions, and it allows patients to believe, quite simply, that doctor knows best. This assumption remains convenient for patients and doctors alike. The task of diagnosing preferences challenges the culture of medicine at its core-in particular, the widespread assumption that the right treatment choice is a matter of science alone.
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Although the rising accuracy of diagnostic tests has allowed doctors to rely less on listening when determining the cause of symptoms, 2 listening is growing in importance when deciding which of the many treatment options best fits each patient’s priorities. Medicine has changed since Osler’s day, in that there are now more diagnostic technologies and more treatment options.
#The silent patient quotes professional#
Generations later, skill in diagnosis remains a source of professional pride for many physicians, while the spectre of a misdiagnosis or missed diagnosis can provoke sleepless nights. The right treatment, after all, depended on the right diagnosis. Like many of his contemporaries, Osler saw diagnosis as the medical profession’s foundational skill. Osler knew that the patient’s story was often critical to an accurate diagnosis. “Listen to the patient: he is telling you the diagnosis,” William Osler urged students he taught at Johns Hopkins and Oxford more than a century ago. We outline a method for making better preference diagnoses. Regrettably, patients’ preferences are often misdiagnosed. Doctors, generalists as well as specialists, cannot recommend the right treatment without understanding how the patient values the trade-offs. 1 Every option for treatment (a term that we use broadly here, to include procedures, tests, and even watchful waiting) has a unique profile of risks, benefits, and side effects. Just as important is an accurate preference diagnosis. Most critically, an accurate medical diagnosis is no longer sufficient to identify the proper treatment. This is good news for patients, but it makes medical decision making more complicated. In recent decades, rapid advances in the biosciences have delivered an explosion of treatment options.
#The silent patient quotes how to#
Al Mulley, Chris Trimble, and Glyn Elwyn outline how to ensure that preferences are not misdiagnosed Correct treatment recommendations require accurate diagnosis not only of the medical condition but of patients’ treatment preferences.