Dr. Dee had a patient with appendicitis who had pain on the left side instead of the right. He did a fine job ’cause he did not succumb to diagnostic perseveration, or D.P.
D.P. is a common error, and one that is easy to fall into. In it, you hold onto your original hypothesis at all costs. At first for all the world the patient seemed to have diverticulitis, but after a couple days it didn’t add up, and Dr. D reversed field and considered appendicitis. A CT confirmed the suspicion, and the patient did well.
In medicine what is is most of the time, but one has to keep in mind what is sometimes ain’t. At times folks don’t understand, but it is why we are very reluctant to ever assume much or diagnose over the telephone. Nothing strikes fear in me more than to have someone call and say, “well, I’m ‘pretty sure’ I have a stomach virus.” (One time when it turns out to be an aneurysm will make a believer out of you right quick.)
Knock on wood; tomorrow might be the day I have a disaster, but I have been saved more than once by not falling into diagnostic perseveration. Most of the time, I got it right ’cause I came, I saw, and I reconsidered a few times in the interview. Often it is because the patient gave me the clues that made me chunk my original theory about what was wrong.
There is an old saying in medicine: “If all else fails, ask the patient. (like reading the directions, I guess) They will usually tell you what is wrong.” That has proved true over and over for me. They might not say “I think I have scleroderma,” but they will sure enough tell you the symptoms that will lead you down the right path if you don’t forget to listen.
For Dr. Dee’s patient, it is a good thing he listened. What it is is, but it wasn’t. Thank goodness his radar was up and he was not bitten by D.P. The patient was happy about it too.