The Diagnostic Process, How Doctors Think

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Good Doctors diagnose with SOAP – Subjective, Objective, Assessment, and Plan.

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In episode 53 of the BioBalance Healthcast, Dr. Kathy Maupin and Brett Newcomb describe the diagnosis process doctors are trained to use when talking to patients about medical issues and creating a treatment plan.

Doctors all go into medical school, normal human beings, or at least mostly normal, and matriculate with minds that think in a deductive way in order to reach an answer to the problem brought to them by their patients. The process of teaching us how to think, completely wipes out our hard drive, and reprograms us. I believe it is important for patients to understand how doctors think, so as patients you can give them the most important information, in the most efficient manner, so they spend most of their time problem solving and not extracting the information they need to begin to problem solve. In this world created by managed care doctors have very little time with you face to face so why not make that time the most efficient for you?

The structure, or order, of the visit is evidenced in the notes doctors write:

S= Symptoms or complaints of the patient
O= Observations, physical exam, vital signs, what you look like
A= Assessment is the initial thought or impression that the doctor has about your problem.
P= Plan or lab tests, radiology, medications, exercise, diet, and when to return.

Help Your Doctor Understand Your Problem Quickly!

That’s it! So, your doctor will enter the room and ask you what’s wrong. At this moment you should tell him or her: 1) Your most problematic symptom, when it started, how severe it is, where you feel or see it, if it is constant or intermittent, and why you are worried about it.

That’s very efficient and it does not confuse the doctor with unnecessary information. My mother in law was truly my favorite relative. She lived with us for the most important 7 years of our daughter’s life and was integral to her brilliance and humor, however she was always a difficult patient to pin down. I would go with her to the doctor and it literally took her a full 15 minutes to tell the problem to the doc. It was intermixed with what she ate today, the subjects of her dreams, her friends illnesses and somewhere in there she would tell the doctor what was wrong. Thankfully she was blessed with patient doctors. After 7 years I had coached her to ten minutes of unrelated symptoms, and helped her doctor by handing him a sheet of paper of her symptoms and the important related problems.

So if you want great care you have to learn to play the doctor train of thought game and start with the main problem. If you are helping an aging parent or a child spend the time on the way to the doctor sorting through the flotsom to get to the problem, and then help them rehearse their symptom description. If you are unable to go to the doctor with a talkative relative, or even a non-talkative teenager, it is acceptable to fax or email the problem and the symptomatology (What, where, when ) to the doctor before the visit to help her.

Your Doctor Should look At You, When they Talk to You and When They Examine You

To diagnose your problem, a doctor needs clues, and after taking your history, your clues are contained in your face, skin tone, skin turgor (tightness, or swelling), bumps, lumps, discolorations etc. Your doctor must LOOK AT YOU to get these pieces of information. If you look totally different than you feel, then tell the doctor that you always look better than you feel so they take you seriously!

I often see patients who come to me, and complain that their doctor types throughout the office visit and never looks at them. This is a mistake of the modern age, as most of us can write without looking, the majority of us cannot type without paying attention, so doctors aren’t getting the clues needed to arrive at the right tests or diagnosis. Vital signs are a pain but generally essential to a Primary Care doctors diagnosis.

Your Doctor will Come To a Conclusion about what is wrong or a list of what Could Be Wrong.

The third step is problem solving. This is the fun part for me, when I have most of the information and I decide what the problem is, or what possibilities are on my list to rule in or out. This part takes rest and time. Generally your doctor will let you in on the things he or she is looking for, or what it could be. If not, then ASK! It is your visit and even though you have to fit your symptoms into a form that is efficient for the doctor, she should tell you what she is thinking of, and what tests or medications you will require.

The Plan: Steps by Step Plan for Diagnosing your Problem

Last but not least, is the list of things you or she needs to do to get to the answer. This is not a secret. Ask for a copy of the plan or take your own notes. It should include drugs needed, expected results, or lab tests, and instructions before the test, radiology scheduling or other testing, and most important, instructions on when to come back and how to get your results and the DIAGNOSIS.

If you came to the doctor’s office with a problem and you leave without a plan, don’t leave. It is like going to the grocery store, spending time picking out your food, paying and then not being allowed to leave with you food!

This is how doctors think—we want to be your doctor-patient type of friend and know what is going on in your life, but if you have a problem, you must switch from a social visit like is common for check ups, to a business meeting, that takes concentration and no extraneous information.

Just like in the service (Marines, Army, Navy) doctors are reprogrammed during training and they are likely unaware that they get the process but you don’t. I believe if you get the diagnostic process you will be much happier with the results of your problem visits and your doctor.

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