Obvious Diagnosis Not Always the Correct One

Q:  I read your response to the mother whose child was suffering from constipation. My daughter had significant problems with constipation and as a result saw many physicians whose recommendations paralleled yours. Despite that, she did not improve. Finally, at the suggestion of a medical student, we began looking into other causes. It turned out that she had a rare condition called sacral agenesis that rendered the nerves controlling elimination essentially inoperable. My point is that physicians have the responsibility to look beyond apparent solutions when confronting common problems.

A:  There is an overused saying in the practice of medicine that states, “When you hear hoof beats, look for horses, not zebras.” There is also another saying: “You can’t diagnose what you don’t think of.” In medical problem-solving, unless there is other convincing evidence at the time a patient first comes to you for care, physicians are trained to look for solutions based on the likelihood that we are dealing with a common problem that has a straightforward solution.

We do patients a disservice when we don’t recognize if that type of diagnosis, especially when repetitively applied, doesn’t work. At the very least this leads to a delay in arriving at the proper diagnosis and at the worst allows a serious condition to progress when an intervention is necessary.

The solution is two-fold. Physicians need to practice the art of medicine by carefully listening to our patients and adopting a wider perspective; and patients and their families must challenge the physician’s recommendations if they don't seem to be working. If an unsatisfactory response to that approach occurs, look elsewhere for help.

It all boils down to communication.

Patients and their families need a good understanding of both the ailment and its effects, and when visiting the doctor should provide any information from previous evaluations. For doctors, it means quietly listening not only to the facts, but being sensitive to the subtexts of what people are saying and being willing to proceed based on that alone - even if the information does not fit the initial profile for the diagnosis in question.

"Your Health" provides easy-to-understand information about common health conditions.