Wednesday, March 23, 2011

After Reading Chapter 2



How did Dr. Fitzgerald go about determining her diagnosis? What mistake did she make? Why do you think happened? Was this a realistic scenario?

33 comments:

  1. all three cases presented to her were actual cases so the process did seem realistic apart from thinking out loud and making a lecture out of it. the first diagnosis she gave up and didn't even make a guess to the disease. she made the biggest mistake when she decided to not have a ct scan done. i think she made this mistake because she was too focused on the monetary aspect. although it should be a part of the thought process, money should not be a focus or a big concern because the primary goal of a doctor should be to make the patient better at all costs.

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  2. Dr. Fitzgerald determined her diagnosis by listening to information about the symptoms, ordering several tests, and hearing part of the patient's life story-as the book focuses on the idea that a patient's regular life may hold the key to the diagnosis. She made the mistake of not ordering a CT scan even though someone in the audience suggested she should. I thought it was kind of weird that she didn't order it, as she mentioned that almost every patient she sees is not admitted without first having a CT scan. She thought it wasn't necessary but in my opinion she should have ordered it anyway since she didn't have an alternative diagnosis. I think she was too sure that other tests would have shown the same results as the CT scan that she didn't want to waste the time or money.

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  3. Dr. Fitzgerald determined her diagnosis by using the basic facts of the patient's problem, instead of using the whole story. She was able to call up the results of various tests that would aid her in determining the patient's illness, but the one test that she neglected to use was the CT scan. Although she had the option of running the test, she chose not to view the results as she assumed that they would yield pretty much she same information that the other tests had shown. By choosing not to run the CT scan, she missed out on a very large brain tumor-- one that she would have easily seen if she had gone through with the CT scan. I think this situation was very realistic, as there are undoubtedly many cases like this where the doctor neglects to run a test that could in fact save their patient's life. Doctors do not have an unlimited supply of time or money, and running extensive tests that could eventually prove to be useless is not always a chance they want to take.

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  4. Dr. Fitzgerald made her diagnosis by ordering tests to gather information about the patient and by using as much of the patient's story as she had. She made a mistake when she chose not to run the CT scan, which would have immediately shown her what the problem was. She didn't order a CT scan because she thought it would give her the same information as the other tests, and would therefore be a waste of her and the patient's time and resources. I think this situation is very realistic. Doctors don't have endless supplies of energy, time, or money; they want to conserve the few resources they do have on something they are fairly certain will give them new information, not something they're sure will be a waste of time.

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  5. Dr. Fitzgerald used a distilled version of the patient's story to diagnose the patient. She ordered different tests that she thought might be relavent, and developed various hypotheses that she tested with medical tests. She did not use personal information from the patients life, only the simplified framework. Her key mistake was not ordering a CT scan of the patient's head. Had she done so, she would have realized that the symptoms were due to a large tumor in the patient's brain.

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  6. Dr. Fitzgerald used a very quick and simplified summary of the patient's medical history in order to solve the cases. She could order tests, and ask questions so it was realistic in that way, but the fact that the actual patient wasn't in front of her made it somewhat unrealistic. The mistake she made was not ordering the CT scan. I don't think she would have made this mistake in real life though. She decided not to get the test because she assumed that such a standard test wouldn't be the answer considering that the goal of the program was to present medical mysteries.

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  7. Dr. Fitzgerald made her diagnosis by compiling a list of facts and symptoms and determining the likeliest cause from that. The biggest mistake she made was not ordering the CT scan, which revealed the cause of the patient's illness. I think this situation was realistic. Doctors do not have infinite resources or time at their disposal and are bound to make mistakes like this at some time or another in their career.

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  8. Dr. Fitzgerald recieved a brief "barest bones" version of the patient's story from a medical student. Using the symptoms described, Fitzgerald developed possible hypothesis which she was able to explore by ordering tests. Her error occurred when she failed to request a CT scan, which would have revieled a brain tumor. Fitzgerald quickly decides against ordering a CT scan because she believes due to the fact that the patient only exhibits signs of confusion, the test would show nothing. Although a description of the patient's symptoms may not have hinted to a brain tumor, had the patient herself discussed her symptoms, the dictor could have stumbled upon seemingly unimportant details that would have caused her to order a CT scan. I think this situation was not entirely realistic because the doctor was performing for an audience that was more interested in seeing the process of a diagnosis than actually seeing Fitzgerald get the right answer. With that in mind, Fitzgerald would not have had to dwell on little details that would slow down her "performance."

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  9. Dr.Fitzgerald makes her diagnosis of many mind-baffling cases after just listening to the patients' symptoms, and ordering tests in order to test her hypotheses. In this case, she did what she usually does and went through all the in formation thoughtfully. However she made the mistake of not requesting a CT scan, which would have revealed her brain tumor. The interesting thing is that she simply laughed her accident off, saying that she always makes mistakes and that it is the learning experience that counts. I think it is a bit realistic because i can imagine many doctors being very sure of what some things are are failing to double check. This then leads to a series of other unnecessary procedures and a waste of valuable time in fixing the problem.

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  10. Dr. Fitzgerald ordered different tests that could possible explain the symptoms exhibited by the patient. She offered any suggestions of possible diagnosis from the audience. Dr. Fitzgerald made the mistake of not ordering the recommended CT scan because the chances of it turning up any helpful information was unlikely. It turned out that the patient had a brain tumor, which showed up quite plainly on the CT scan. None of the medical students were upset with the fact that the doctor had gotten the diagnosis wrong because they were more interested in the process. This fact relates to a later part of the chapter where it describes how some doctors become more interested in the disease and and the intellectual stimulation than they do in the actual welfare of the patient. In real life, even if the process of diagnosis is brilliant, if you don't accurately find the problem, the patient will die. The lecture was a safe environment because no lives were at stake, but in reality, this would not be the case.

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  11. Dr. Fitzgerald determined the diagnosis by using the patient's medical history, learning about her symptoms and ordering various tests she deemed appropriate that would help her make a hypothesis concerning the patient's condition. The mistake that she made was that she decided not to order a CT scan because she assumed that the answer she was looking for would not be in the CT scan. I think that Dr. Fitzgerald did not order the CT scan because assumed that since they were doing a differential diagnosis exercise, the answer she was looking for would be obtained from much more obscure, not as obvious information. I don't think this is a realistic situation because in real life I dont think she would have made the mistake of choosing to not get a standard test because she would first try to look for obvious clues into what was wrong with the patient.

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  12. First, Fitzgerald listened to the description of symptoms of the patient. Then, she requested the results for a few tests, specifically a spinal tap. Her next move was to explore the various areas of medicine that could lead her to the diagnosis. She considered both congenital and infectious diseases. Finally, she asked for suggestions from the audience. Her error was to refuse to order a CT scan, thinking that it would prove fruitless. However, the affliction revealed itself to be a tumor, something that would have been obvious with in the scan. The scenario is realistic in some ways, as it contains the empirical elements of a diagnoses. In other respects, it is not so realistic. She did not have a chance to examine the patient herself, and she had to diagnose in a shorter period of time than would usually be the case.

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  13. For me, this chapter represented the classic challenge of finding human emotion in positions where lives are put at stake. Is it better for a soldier not to feel remorse? Is it better for an IRS representative to feel no sorrow when he informs someone that their house is being taken from them? Is it better for a doctor to take the patient out of the equation, and simply put all of his/her effort into a case, stopping at nothing to find a remedy? Sanders notes in this chapter that the line between case analysis being about the patient's well being and being about the best way to get to a diagnosis is beginning to be grayed. For someone who values the story of a patient at the highest level, Sanders finds the conference in Philadelphia alarming. Fitzgerald's choice, in her nonchalant approach to solving a difficult diagnosis case in a purely academic manner, to disregard a simple recommendation from the audience (to use a CT scan) was in the end fatal. This "patient" was not a real person in Philadelphia. Nor had the people in the room even met the patient. However, the crass and purely educational approach to the process of diagnosis makes me, and it seems also Lisa Sanders, fear for a future in which the patient will become his/her illness.

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  14. Dr. Fitzgerald used a very brief and distilled version of her patient's story from the medical student to make her diagnosis. She developed an idea of what the cause of the symptoms was, but she had to order tests to figure out if she was right or not. Her biggest mistake came when she decided not to order the CT scan which would have immediately shown her what was wrong with the patient. She chose not to order the CT scan because the believed other tests would show her the same results and it was not worth "wasting" her patient's resources. I think while that is an important aspect, she should have at least ordered the CT scan at the very end, just to be safe. Otherwise money determines whether someone lives and dies, which is probably bad. I think this is a very realistic scenario since doctors are pretty distanced from patients because of the "medical language." Doctors want to get the patient better as fast as possible without overusing resources.

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  15. Dr. F made her diagnosis by asking questions and running tests and as the possible diseases were narrowed down she tailored her analysis and further inquiries appropriately. Her biggest mistake was obviously not ordering the CT scan because if she had she would have seen the bright white mass instead of just being completely dumbfounded. Since these were real cases presented to her it did seem pretty realistic, however, some of the mistakes she made, like not ordering the CT, seemed to be more to prove a point about how easily things can be overlooked. On the other hand, she did mention that she didn't have any reason, whatsoever, to order the CT because the patient expressed to signs that would lead her to conclude it was needed, nor did his test show up abnormal. This is the part that is scary, that live saving measures can be easily taken but often over looked without a completely thorough exam, but are often overlooked because the majority of the time this extreme thoroughness is unnecessary.

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  16. Matt and David again:

    Dr. Fitzgerald did not actually write "The Great Gatsby." Instead she worked to diagnose the disease of her patient. Her students presented her with ideas of what tests to take, and she quickly came to a conclusion of which tests she wanted. As the book states, "she quickly called out tests", seemingly taking little time to think. She seemed to base all of her diagnoses on medical information, mainly the patient's dementia, taking barely any importance in the personal life or background of her patient. The largest mistake she made, however, was not ordering the CT scan that one of her students suggested. She decided to skip it because her patient apparently had "no neurological findings." Yet, the majority of her patients are normally not even allowed to see her until receiving a CT scan. This anecdote proves the book's point that a doctor with their patient, and focus on their story, rather than rely on medical facts.

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  17. This scenario was obviously not realistic; a lecture at a conference is quite different from a real case at a hospital. As the remainder of the chapter points out, a list of symptoms and test results on a piece of paper lacks the potential for a human emotional response or high stakes scenario that are possible with interaction with a flesh and blood patient. Absent from a lecture are the resulting pressures that accompany a real patient. It is quite possible that Fitzgerald would have behaved differently had she been presented these symptoms in an actual patient. Fitzgerald herself reveals how unrealistic the lecture scenario is. She says that "in my hospital it's almost impossible for a patient with mental status changes to come through the ER without getting a head CT." Thus, had this patient come into a real hospital, a CT would have been ordered, and the diagnosis would have been made quickly.

    Fitzgerald's biggest mistake was assuming that this patient fit the mold of the average case. In my opinion, this was a rediculous mistake, given that the premise of the lecture was to present her with an unusual case.

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  18. Dr. Fitzgerald (pompously) would ask for only the bare facts of the situation. She joked around that diagnosticians simply play game quite similar to jeopardy or wheel of fortune. Her mistake was not ordering a Head CT to actually clarify what the patient's ailment was. This happened because she didn't have the time/energy to waste resources. I think situations like this are common, but with one caveat. Usually the forgotten test is not a head CT. Fitzgerald even remarks on how almost all patients have head cts. What is common, though, is the rushed approach that doctors can give to medicine. With issues such as malpractice and health insurance, many doctors have to limit what is actually best for the patient. Because of this, many tests that are considered expensive, risky, or laborious do not get performed as often. Unfortunately, these tasks may be the ones that are proven most necessary to a successful diagnosis.
    Thanks,
    Sarah

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  19. Dr. Fitzgerald used the information Nasir provided to attempt to create an accurate diagnosis. She used the different pieces of information to both eliminate potential problems and introduce more possibilities. In the end, she was "stumped" because she disregarded the CT scan. Dr. Fitzgerald believed she would not gain any more information from the CT scan, because she thought the chances of gaining information from the CT scan were low. Had the situation been more realistic, Dr. Fitzgerald may have already seen such a scan (assuming the patient went through ER). As she did not interact with the patient, Dr. Fitzgerald could only have an objective viewpoint, preventing her from using experience she had gained from dealing with patients face to face. Surely, interacting with the patient in the hospital would have aided Dr. Fitzgerald more in developing a better diagnosis.

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  20. I thought that is was very interesting that Dr. Fitzgerald couldn't solve the first case. I would have thought that a tumor would be quite simple to diagnose. Her fatal mistake was overlooking the CT scan, which would have revealed the tumor. She thought that it would just be a waste of time but it was vital to the diagnosis. I think that if it were a real scenario and the doctor met the patient, she might have been able to diagnose the patient right. These scenarios are close to being realistic but they lack the patients story, which would benefit the doctor in figuring out the diagnosis.

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  21. Dr Fitzgerald came close to finding the patient's disease by following the story and symptoms, but ultimately missed the diagnosis of a tumor because she didn't order a head CT scan. I think that a part of why she missed it may have had to do with the forum in which the case was presented; since tumors are relatively common diseases, Fitzgerald may have been expecting something not as well known that a head CT wouldn't have revealed.

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  22. Dr. Fitzgerald tried to diagnose her patient by listening to his story and paying attention to the symptoms the patient relayed to her. Her mistake, however, was that she did not order a CT scan of her patients brain. This mistake prevented her from making a diagnosis that would have otherwise been easily achieved. I think that she overlooked having a CT scan because, as a doctor, she may have encountered an illness caused by similar symptoms this patient exhibited and immediately assumed that the patient had that particular disease. This scenario seems to be realistic because doctors have a vast knowledge of many diseases and may overlook simple tests, such as a CT scan, and jump to a quick diagnosis of a patient.

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  23. Dr. Fitzgerald went about diagnosing her through her medical history and listening to the patients symptoms. During this process she did not order a test critical to her eventual diagnosis: a CT scan. She chose not to run a CT scan because the results from it can often be seen through the result or compilation of results from other various tests. This error caused her not to miss a large tumor. I think that this is very realistic because even though most patients under go unneeded tests some doctors try to avoid them like in this case. Unfortunately this was a time where an often unhelpful test would have made a big difference.

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  24. I'm not sure where my last response went, but heres basically a repeat. Obviously Dr. Fitzgerald messed up and didn't order a CT scan. However the reasons for the mistake were not simply because she was a bad doctor; obviously she had experience to recognize what the CT scan could mean. However, she was constrained by certain conditions that make her medical practice much harder; time constraints and monetary constrains both "constrain" what doctors can do to certain patients. That means that it becomes harder to make correct diagnosis's (excuse that). Fitzgerald is a tragic example of the failure to address concerns in the medical profession.

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  25. Dr. Fitzgerald diagnosed the patient using the history she obtained from her patient as well as through observation of the patient's symptoms. However, She failed to correctly solve her patient's dilemma by forgoing a CT scan, a procedure that oddly enough is one of the first tests she would normally have ran on her patients. Regardless of whether or not other tests could confirm what a CT scan could also show, she should have done it because you can never be too sure when dealing with any disease. I believe that it is better to have more than one method when arriving at an answer; she would have done the CT scan to confirm her findings of her other tests. What if she performed them wrong? There was no evidence that she performed her other tests more than once, so she could have easily made a mistake. She did not go through with the test, however, because it would have cost extra cash, she didn't have the time to do it, and obviously she thought her other tests covered the areas the CT would have covered. This problem with "time" and "money" need to be solved in order to allow for better results in all patients in the future.

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  26. Dr. Fitzgerald's "mistake" was not ordering a CT scan of the patient. However, as Dr. Fitzgerald pointed out the patient wouldn't have gotten through the emergency room without a CT scan. She should have anticipated that the diagnosis would be something out of the ordinary: eg. a tumor that was too large to have presented itself on oter similar exams that she had ordered. However in a really hospital, doctor-patient scenario, why would the doctor assume anything is out of the ordinary? She made a "mistake" in the lecture because likely would not have happened in really life. It might have been a useful teaching tool to demonstrate to the audience how they must anticipate such errors in their hospitals, but it was not explained as so. Dr. Fitzgerald simply moved on to the next scenario.

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  27. Dr. Fitzgerald first learned an abridged doctor style of a patient's history. It may have been edited so that some of the useful information was missing, a problem Dr. Sanders highlights. Next, she was given a list of the symptoms of the patient. Then, she was allowed to order any tests that may have been necessary. Her mistake was not ordering a CT scan because she believed that any brain tumor would have other, more obvious symptoms. The CT scan was superfluous. Of course, this woman had a large brain tumor. Maybe if the story given to her had been the patient's story, instead of a doctor's edited version of a patient's story then the diagnosis would have been different. However, Dr. Sanders seems to suggest that it would not have made a difference because the problem of doctors ignoring the patient's detailed story to focus on their critical buzzwords seems systemic. This scenario, while it did happen, is not common because of the difficulty of the diagnosis.

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  28. Dr Fitzgerald was only given a simple description of the patient. She never encountered the patient, but had to make a diagnosis based solely on information. Her lack of a CT scan is what caused her incorrect diagnosis. I think this happened mainly because it was not a patient in front of her. Had she seen this patient and been through the pressure (she was very calm on stage), she might have been more willing to think outside the box. Although it may not be common, this situation is certainly realistic, as it did come from an actual patient. Although Dr. Fitzgerald got it wrong, i think its very different in the real world from a lecture. As the other doctor said, the other doctors are there to learn about the thought process, not to judge her on her ability to create a correct diagnosis.

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  29. Dr. Fitzgerald determined her diagnosis though a number of tests. However, one mistake she made was focusing simple on the disease and the symptoms as opposed to the patient. More concretely, she did not order the CT test, because she deemed it not valuable compared to the cost of the scan. The set of symptoms is realistic, but the lecture is not at all what it is actually like to diagnose a patient. In a more realistic set up, the doctor would have been dealing directly with the patient, so she would have made the diagnosis differently.

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  30. Dr. Fitzgerald attempted to formulate an accurate diagnosis by listening to the information provided by Nasir. She never actually had contact or time with the patient, and could only rely on information. Her huge mistake was to not order a CT scan to clarify the patient's ailment. Although this situation is not common, it probably is realistic. Doctors face many challenges that don't include dealing with patients such as time, money, and stress. I am sure that doctors make incorrect diagnoses simply because they don't use every tool possible. Whether you like it or not, doctors are rushed and problems such as this one can happen. it is a tragic truth in the medical world.

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  31. Dr Fitzgerald made her diagnoses by looking at the information provided by the student in the patients' histories and physical symptoms. She made the mistake of not getting a head CT because she thought that because there had been no neurological findings and her only symptom was extreme confusion, she would not find anything in the brain. It seemed like she tried to make it more realistic (even though the hospital, she said, almost always gets head CTs for patients with mental status changes) by not getting a head CT, because she thought it wouldn't reveal anything, but that ended up being her mistake. In a way it wasn't really realistic because she didn't do what her hospital would normally do, but she really didn't think, reasonably, that it would show anything.

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  32. Ingrid Adamson-SmithMay 24, 2011 at 3:05 PM

    In her attempt to diagnose the patient, Fitzgerald thought about different areas of medicine in which the culprit might have lurked in developed a list of possible causes. She ended up making the mistake of not getting a head CT because of her over-confidence in the lack of neurological findings. While I do think that this is a realistic scenario, it seems that were Fitzgerald faced with a real patient, she would be a bit more careful with such a hard-to-diagnose case. It seems like she would realize, perhaps after a few incorrect diagnoses, that the answer must be hiding somewhere she had overlooked.

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  33. Dr. Fitzgerald makes her diagnosis of many confusing and challenging cases after doing nothing but listening to the patient's history and interpreting the tests they had to determine the identity of their disorder. In this case, she went through her normal checklist of mental tests she would perform on a given patient and she did each with thought. But it's interesting how the thing that she did wrong she commented on how although she got the diagnosis wrong, she saw it as a learning experience, not as a failure. I think it's realistic, but I'd definitely prefer a doctor that doesn't overlook anything and orders any test that might assist him/her in his/her diagnosis. Although there may be many extraneous procedures, the possibility of him/her getting the right diagnosis would be better.

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