Module 5 post

Much of my clinical decision making is based on past experience.  I can usually recall something in my clinical experience that relates to the present and proceed from there.  The problem, however, comes when something does not truly fit the mold you are trying to use.  For instance, in my specialty(continence specialist) patients come for a variety of reasons but often present with the same symptoms.  Patients coming with urgency and frequency could readily be lumped into the "purple pill" category--OAB.  But there are many diagnosis that present with that same set of symtoms i.e. ISD, prolapse, stricture, IBE, etc.   The treatments are completely different. 

I remember in my Master's program an instructor reminding us not to jump to conclusions everytime that "sprained ankle" comes through the door.  You may miss a very important diagnosis.  We are taught elements of critical thinking for this very reason.  Hunches and experience can be helpful and may help direct a decision making process but should not overshadow the need to utilize the learning we've received.  

I recently went to a neurologist with my daughter.  She was having some severe obstructive sleep apnea symptoms.  During the visit he kept asking what I thought were "bizarre" questions.  I felt he was wasting my time as it was pretty clear to me. 

The testing was done and the sleep specialist diagnosed obstructive sleep apnea.  Upon our f/u visit the neurologist informed me he did not feel the reading was accurate.  We did a second testing which confirmed actual narcolepsy and cataplexy.  She had been misdiagnosed her whole life and now at age 19 is being treated and doing very well.  I have great respect for this doctor who didn't categorize us in the usual manner but treated us as a new entity and was able to diagnose a rare but life altering diagnosis for us.  The interesting part was the sleep specialist who read the test was my cousin and he was telling me the doctor was just being "neurotic".  What a lesson for me as I treat patients and truly listen to their symptoms.