Saturday, June 7, 2008

Self Diagnosis

The other day I had an interesting patient. She was very forthcoming about her symptoms.This is what she said
' From yesterday morning my Spondylosis began troubling me.It started at the base of the neck and then spread up to all nerves in my brain.From evening onwards it was my Sinusitis with unbearable pain around my eyes. Today morning I was better as I slept with out a pillow. But by afternoon because of my new glasses [ which I began using one month ago] I had dimness of vision and watering of eyes. As I felt bad I took a pain killer which produced 'Gas' in my stomach and I had to vomit.
Many patients describe their illness like that.They will have all the diagnosis ready.They are so sure of the reason for their illness that sometimes I feel why they had come to me.May be just to confirm the diagnosis? Or to show off their medical knowledge?
With such patients it is very difficult to get a true account of his/her symptoms.A patient should try to tell the doctor what symptoms he/she felt, the order of occurrence of symptoms[chronology],what triggered/aggravated and what relieved the symptoms etc.It is better not to tell what he/she think is the cause of the illness unless asked to by the doctor.Let the doctor reach his/her own conclusion.
If the patient already come with a diagnosis of his own,there is a strong tendency among doctors to come to the same conclusion which many a time may be incorrect.Especially it happens with less experienced doctors working in Emergency Department. Several times I had seen the diagnosis given by the patient written down in the case sheet from the emergency department overlooking glaring clinical evidence to the contrary.This sometimes result in delay in diagnosis and unnecessary medications.
Ideally the above described patient should have told me about her symptoms like this.
'Yesterday morning I felt pain on the lower part of back of neck which slowly spread up to my forehead.By evening that pain was less but I had severe pain around my eyes.Today morning i felt better,I don't know why.But by afternoon I had some dimness of vision and my eyes started watering along with headache.I took a painkiller but after some minutes I vomited'.
However smart you are, it is always better to leave to the doctor the job of finding the cause of your illness.


Anonymous said...

Sir, here is P.A. again.

Ofcourse it is bad, if a doc. is overstrain the diagnosis given by a patient. But why a patient is doing this? I dont think that they just want to show off their med. knowledge. They might do this, bec. they are afraid of a bad diagnosis. So its better to tell yourself it is this or that (not so bad) instead of telling just the symptomes and then you might hear a serious, bad diagnosis.

Instead of blaiming that ppl (which have obiously a fear of being seriously sick), a doc should listen to that(which i would call sympathy for his pts) and then "start again" and ask just for the symptoms and build up his own "mind". But i guess that would take too much time. And time is money.

Thats my oppinion.
Have a nice day. P.A

charakan said...

Self diagnosis is mostly due to some fixed idea in the patient's mind about his/her illness, some sort of obsession.He/she might had already underwent several diagnostic tests with results to the contarary but the obsession remain. Experienced doctors may be able to understand this as an obsession but in a crowded emergency dept a junior doc may get mis-directed.In an emergency department only time matters not money.Seeing the next patient will be delayed and the doctor's brain will be more stressed out.
If you had similar symptoms and the diagnostic work up had revealed the diagnosis it is better to tell your doctor that.It will save time.
Yes I can understand the fear about bad diagnosis especially if it is your first consultation and the doctor is also new.Even then you should try to describe your symptoms fully and only at the end you can tell the doc that you feel it is due so and so illness.

Anonymous said...

:) ok ... you are the doc ...