How can I get good at making diagnoses? (and be a ‘good doctor’)
Two hard questions. They are intrinsically linked. To be good at making diagnoses you need to be a good doctor – and vice versa.
To do that you need KRED, i.e. to combine kindness and determination, with two branches of philosophy (rationalism and empiricism).
Essentially that means combining:
- Kindness – be kind and caring at all times. Full stop. You will often find the NHS (especially its IT!) frustrating. Don’t take that out on the patient. Its your job to get around those barriers on behalf of the patient.
- Rationalism (logical reasoning) – this can only come from experience through practice (see determination below). What is the most likely diagnosis based on initial information and data?
- Empiricism (lateral thought) – try to remove bias, and ask yourself what might be an alternative diagnosis. What if you are wrong? Do you need to make sure the treatment covers two or more diagnoses?
- Determination – combine the above with hard work, honesty, careful observation (both listening and non-verbal communication), good knowledge and clinical skills, reliability and humility .. and most importantly .. practice.
- Practice, practice, practice (practice). You need to be determined to see 1000s of patients. Five years after qualification, you will start to be good at making diagnoses.
- Ask yourself, if you are not sure .. do I need to ‘phone a friend’, i.e. consult a colleague? All good doctors will come to your aid if you ask them. Just ask them. All questions are good questions.
- Part of determination is ‘FTJ’ = finish the job. Have you got any mental energy left? You need this, for example, to chase and act on a key blood test or scan; or physically go and see that specialist who has not responded to a bleep or email – and drag them to see your patient.
Advice for doctors and all health professionals – re precision in language used
It is important for all health professionals to be precise in their language. For example, phrases like ‘urosepis’, ‘chest infection’, ‘Trop-T negative chest pain’, ‘off legs’ or ‘acopia’ are not syndromes or diagnoses.
‘Bed-blocker’ is plain rude, unkind, and shows a lack of respect for the elderly. Do not rush the elderly. They need time. You will be old one day.
These are all ‘non-diagnoses’. They are not helpful, represent sloppy medicine and are to be avoided.
Further reading – Cartesian rationalist thinking
Much of the method of forming diagnoses originates in the ‘Western Medical method’ based on Cartesian thinking – i.e. from Rene Descartes, the French philosopher and mathematician – as explained here. Descartes promoted a form of philosophy called rationalism.
This is also the basis for what is called the ‘Scientific Method’, of which Medicine is part.
Back to where we started
If you are not kind to the patient, they will not trust you and you will get nowhere.
