This started out as a blog about why medical diagnoses may be missed; but I thought it would be helpful to talk first about what success looks like–or rather, what a successful diagnostic process can look like.
It’s a lot more than just nailing the diagnosis. Ideally, it should include:
- A clear explanation of the diagnosis;
- Education about the condition;
- Explanation of treatment options and potential outcomes of those decisions;
- A brief description of common side effects associated with any prescribed medication;
- A plan for next steps.
What success looks like
“Georgina” went to see Dr. E, a dermatologist at her university’s student health center, because she had itchy red bumps on her skin: she was literally scratching the skin raw when they would appear between her fingers or in the crook of an arm. The rash had mysteriously returned on and off since she was a kid, but now, in graduate school, it had taken a turn for the worse.
The diagnosis was not a difficult one: the cause of the skin rash was eczema.
But it was the way her doctor explained the diagnosis and offered treatment for it that makes this a beautiful example of success.
Dr. E. took the time to explain the diagnosis–including why it occurred, how to prevent it, and how to treat it.
“Eczema is sometimes called the “itch that scratches,” Dr. E told her–and what Georgina had been experiencing is known as the “itch-scratch cycle,” she said. “That means, the rash often starts with the skin feeling itchy: there is no rash, but the skin itches, and once you start scratching, you’re off to the races. The more you scratch.. the more it itches … and the more you scratch.”
Once the rash is treated, Dr. E told Georgina, it is easy to prevent the condition from getting out of hand by:
1/ Being aware of the itch-scratch cycle and not letting it start by using preventive moisturizing creams before the cycle gets going. Georgina should keep the skin moisturized with a skin lotion that is fragrance free–Dr. E gave the name of three very good ones–Moisturel, Curel, Eucerin–Georgina could figure out which she liked best. Put it on right after a shower or bath.
2/ Once the process has started, Georgina should start treatment with a topical steroid before it gets bad.
Dr. E then went on to explain the side effects of treatment: “it is important to be conservative with the steroid cream,” she said, “because it causes the skin to thin–in addition to a laundry list of other side effects.” Georgina should never use it on the face, because it may cause spider angiomas–enlarged veins– that do not go away.
Education
But Dr. E. went beyond that. She explained that eczema was part of something known as the “atopic triad”–that this condition is often associated with two other allergic diseases, allergic rhinitis or seasonal “allergies”, and asthma. She told her that these three tend to run in families, and sometimes may all occur in the same person. Indeed, several of Georgina’s family members had been diagnosed with one of the three conditions.
And then the doctor reached into a drawer next to her desk and took out three articles about eczema that she gave to the patient.
All of that took less than 10 minutes.
Not as easy as it might seem
Based on that experience, one might think that this should not be a difficult diagnosis to make, explain and treat–but that is not always the case. Why? Lots of times–the ball gets dropped. If you come out of an appointment without a diagnosis, or treatment–advocate for yourself and ask for them! I can’t tell how many times I have seen one or more of those steps missed. It’s happened to me. So–advocate for yourself and make sure you get the guidance you need.
Perhaps the diagnostic process outlined above doesn’t happen because providers fear it will take too much time–time that many providers no longer enjoy. If so, perhaps one solution for providers might be to have handouts–online on or paper–trusted resources that patients can be steered to–particularly for common diagnoses that should be fairly straightforward. Yet I have found sharing of any resources following diagnosis to be the exception, not the rule.
There is good reason to make the effort. Knowledge is not just empowering; it heals by freeing us from the sometimes agonizing state of uncertainty.
Bottom line: it is much easier to know what a good diagnostic process looks like when you have had that experience yourself. Perhaps this example of what the ideal patient-doctor interaction can be like will offer some guidance on what to ask for. This would include:
- A clear explanation of the diagnosis;
- Education about the condition;
- Explanation of treatment options and potential outcomes of those decisions;
- A brief description of common side effects associated with any prescribed medication;
- A plan for next steps.
If this isn’t what you are getting–ask for them! You might not be able to get all of those things in one appointment– then schedule another. But don’t forget to keep asking questions until you get your questions answered.
Medical Disclaimer:
All patient names are changed to protect patient confidentiality.
The suggestions given here are not intended as a substitute for the medical advice of your physician. The reader should regularly consult a physician in matters relating to his/her health and particularly with respect to any symptoms that may require diagnosis or medical attention. For additional questions, please call your healthcare provider for reliable, up-to-date information on testing and symptom management of all medical concerns.
