Q&A Tuesday: You Have To Think Of It.

Q:    How are some doctors and lawyers able to see the right diagnosis, the right legal story?

A:    They think of it before they call it.

I often read At First Glance by Lisa Sanders, MD, in the NYTimes Sunday magazine.  The process of sleuthing this week's befuddling health issue to an actual diagnosis often reads like a who-done-it.  You never know what you'll uncover.

Today I learned more than how to diagnose the unusual case of acromegaly in a middle-aged woman.  I learned that the process of inquiry is key.  Excerpt.

"How was Dr. Lesser able to see such subtle changes brought on by her tumor? Experience. He told me that he had diagnosed early acromegaly in two other patients before her. Of course he tested many other patients who ended up not having the disease. When you let subtle physical findings trigger your suspicions, you are going to be wrong more often than you will be right. Still, being right with a disease like this can make all the difference.

Dr. Lesser told me that in medical school, a teacher once asked him what the most important factor in making an unusual diagnosis was. Dr. Lesser was stumped. You have to think of it, the older doctor told him. The teacher went on to say that his father had died from a very unusual disease — botulism — because no one considered it a possible cause of his symptoms. “It’s the same with acromegaly — you have to think of it before you can diagnose it. And I do.”"

TIP:    Trust your instincts or hunches when something nags at you about your patient, case or client.

TIP:    Follow up on your instincts or hunches to discover where they will lead, what they will uncover in terms of facts - especially those no one else considered.

TIP:    Think of all possibilities; consider that the sound of hoofbeats outside the window just might be a giraffe (as a surgeon once told me) and not a horse.