I would add that patients will say, "I can't breathe," when what they mean is that they have nasal congestion. My dear husband is one of those and it really has forced me to respond more deliberately to that statement.
THIS is one of the best reasons to be slow to adopt AI in medicine. As a psychiatrist, I can assure you that ambiguity in language, especially in medical history-taking, is the rule and not the exception. And how about the meaning in the pregnant pauses?
So important to precisely characterize "I'm dizzy"
. As you described "Fatigue.. might be describing tired, or weak, or sleepy, or short of breath" .
Fatigue is a common, nonspecific symptom that we all feel at times. It is more common as we age and it can be challenging for both patients and physicians to sort out when it needs to be further evaluated.
Occasionally, fatigue is the only symptom of a significant cardiac condition, but more frequently in the patient population I see it is either noncardiac (low thyroid, anemia, etc.) or iatrogenic.
This is funny. Imagine when your languages cross. I wrote about this a year ago, when a friend called to described her Mom's problems - she said it pains in the "pag" in Gujarati, which I took as foot, when what she was referring to was the knee - "pag" means "leg" and many people take that as a generic for any part of the lower limb. https://www.bhavinj.com/medmuse05/
I'm so happy that you described/named a psychological process that I have gone through so many times! But, you almost lost me with "platonic truth." Too much like team building for me. I am reminded that my concrete self will often ask patients " have you ever been stabbed with a knife in your back? How do you know what that feels like? I need to let that go as platonic truth; you have releived me of the compulsion to dispute the platonic truth and just carry on with the process. :)
“Woozy” and “the Flu” chased me out of Primary Care.
“Yeah, I had the Flu”
"You had a fever and were coughing?"
"Oh no I had a 1. Headache 2. Diarrhea 3. Nausea 4. Pain in my foot”
Although I was given many opportunities I never went anywhere in Management because I couldn’t role play or participate in team building exercises. And, given the choice whether to attend that “important" meeting where it would be decided who would be responsible for separating the large paper clips from the small paperclips OR run back up to the Unit to attend a crashing patient myself instead of issuing orders by phone during the meeting, I always chose the latter.
After a while they stopped putting me on those Committees and I remained mostly a clinician for 35 years.
“To say I hate team building exercises is a gross understatement.”
I used to want to crawl out of my psych education when that kind of doo doo was suggested at admin meetings.
That being said my patient population would immediately calm down when finding out PAWS (post acute withdrawal syndrome) was not uncommon. Sometimes learning that we are “normal” within the abnormality is all we need.
Dr. Cifu, I often have this sense it would be fun to have a conversation about the topics you write about in the Friday Reflections. I love the "dizzy, dammit!" note, too.
Once, during an off-site office "team training," we were to break into small groups to "discuss a personal goal and identify three steps to achieve that goal." I refused (as discreetly, graciously, and politely as possible). Funny enough, no one seemed upset. They got on with their goal discussions just fine without me.
I guess it’s a good thing your patients can at least try to describe their symptoms. In my work setting (Geri psych), the PCPs frequently refer the demented or non-verbal patients to us immediately when behaviors change or escalate.
It’s frustrating referrals are made so often before medical causes are considered to be a source of the behavioral or mood changes, which they often turn out to be. It can be extra challenging to figure out, but rewarding when solved.
Ok...does it fail to launch, or do you get an error message? Are you using a web browser or installed program?
"It just doesn't work!"
When I log i to the computer, I learn they run Outlook at least a decade old, and when launched iit gives a pop-up message that the version is no longer supported, with a link to install the latest version.
That's me, sorry, but to be fair, IT uses words that already have meanings to mean something entirely different. "Format the hard drive" doesn't sound so bad at first....I'm so glad you can remote in! By the way, I did see the pop-up but something unintended ALWAYS happens when I click on the pop-up so it's ultimately better to wait until YOU say it will be OK. I also saw the movie War Games when I was at a formative age, you know--unintended consequences.
I know that the teaching mantra is to not anchor too early. How do you pull that off though, Adam, when patients are scheduled every 15 minutes? I’m not sticking a needle in that big toe- let’s try some NSAIDS instead! I trust a little pattern recognition in my aging physician mind. BTW, you and your buds( John, VP etc.)-please keep up your great efforts. You’ll are important voices in trying to steer this profession in the right direction.
Thanks so much Walter. Don't you think as you go on, the things you anchor on early are more and more likely to be right? (I might just be trying to make myself feel better before I head to clinic...).
In Hand Surgery, our problem with language is nomenclature. I was in preop checking consent. I asked my patient which finger I was going to operate on. He said his index finger. I was puzzled. The consent indicated the long finger. I asked him to show me, and he gave me "the finger," i.e., his middle finger,
One day in clinic a mother complained that her daughter was "popping" in the middle of the night. Sorting out symptoms with this family was always a challenge because they seemed to dwell in an alternate universe.
I would add that patients will say, "I can't breathe," when what they mean is that they have nasal congestion. My dear husband is one of those and it really has forced me to respond more deliberately to that statement.
THIS is one of the best reasons to be slow to adopt AI in medicine. As a psychiatrist, I can assure you that ambiguity in language, especially in medical history-taking, is the rule and not the exception. And how about the meaning in the pregnant pauses?
Role play 👎 Art Institute 👍🏻
Excellent.
So important to precisely characterize "I'm dizzy"
. As you described "Fatigue.. might be describing tired, or weak, or sleepy, or short of breath" .
Fatigue is a common, nonspecific symptom that we all feel at times. It is more common as we age and it can be challenging for both patients and physicians to sort out when it needs to be further evaluated.
Occasionally, fatigue is the only symptom of a significant cardiac condition, but more frequently in the patient population I see it is either noncardiac (low thyroid, anemia, etc.) or iatrogenic.
I was inspired to write about beta-blockers and fatigue by a patient who said he felt logy (https://theskepticalcardiologist.com/is-an-unneeded-beta-blocker-making-you-feel-logy/) and since then I use that word as much as possible.
A team meeting/committee meeting is a group, who as individuals cannot make a decision, but together can arrive at the wrong decision
Ben Hourani MD, MBA
This is funny. Imagine when your languages cross. I wrote about this a year ago, when a friend called to described her Mom's problems - she said it pains in the "pag" in Gujarati, which I took as foot, when what she was referring to was the knee - "pag" means "leg" and many people take that as a generic for any part of the lower limb. https://www.bhavinj.com/medmuse05/
I'm so happy that you described/named a psychological process that I have gone through so many times! But, you almost lost me with "platonic truth." Too much like team building for me. I am reminded that my concrete self will often ask patients " have you ever been stabbed with a knife in your back? How do you know what that feels like? I need to let that go as platonic truth; you have releived me of the compulsion to dispute the platonic truth and just carry on with the process. :)
“Woozy” and “the Flu” chased me out of Primary Care.
“Yeah, I had the Flu”
"You had a fever and were coughing?"
"Oh no I had a 1. Headache 2. Diarrhea 3. Nausea 4. Pain in my foot”
Although I was given many opportunities I never went anywhere in Management because I couldn’t role play or participate in team building exercises. And, given the choice whether to attend that “important" meeting where it would be decided who would be responsible for separating the large paper clips from the small paperclips OR run back up to the Unit to attend a crashing patient myself instead of issuing orders by phone during the meeting, I always chose the latter.
After a while they stopped putting me on those Committees and I remained mostly a clinician for 35 years.
I tell students to always visually verify “hemorrhoids” since so many people describe any problem “back there” as hemorrhoids.
“To say I hate team building exercises is a gross understatement.”
I used to want to crawl out of my psych education when that kind of doo doo was suggested at admin meetings.
That being said my patient population would immediately calm down when finding out PAWS (post acute withdrawal syndrome) was not uncommon. Sometimes learning that we are “normal” within the abnormality is all we need.
Dr. Cifu, I often have this sense it would be fun to have a conversation about the topics you write about in the Friday Reflections. I love the "dizzy, dammit!" note, too.
Once, during an off-site office "team training," we were to break into small groups to "discuss a personal goal and identify three steps to achieve that goal." I refused (as discreetly, graciously, and politely as possible). Funny enough, no one seemed upset. They got on with their goal discussions just fine without me.
Wonderful piece! OMG - the memories…!!
I guess it’s a good thing your patients can at least try to describe their symptoms. In my work setting (Geri psych), the PCPs frequently refer the demented or non-verbal patients to us immediately when behaviors change or escalate.
It’s frustrating referrals are made so often before medical causes are considered to be a source of the behavioral or mood changes, which they often turn out to be. It can be extra challenging to figure out, but rewarding when solved.
My experience in IT is depressingly similar.
"My email isn't working."
Ok...does it fail to launch, or do you get an error message? Are you using a web browser or installed program?
"It just doesn't work!"
When I log i to the computer, I learn they run Outlook at least a decade old, and when launched iit gives a pop-up message that the version is no longer supported, with a link to install the latest version.
And DH the IT guy says, "I can't breathe" when he means his nose is congested, so we call it a wash.
That's me, sorry, but to be fair, IT uses words that already have meanings to mean something entirely different. "Format the hard drive" doesn't sound so bad at first....I'm so glad you can remote in! By the way, I did see the pop-up but something unintended ALWAYS happens when I click on the pop-up so it's ultimately better to wait until YOU say it will be OK. I also saw the movie War Games when I was at a formative age, you know--unintended consequences.
Love it. Such a good parallel.
I know that the teaching mantra is to not anchor too early. How do you pull that off though, Adam, when patients are scheduled every 15 minutes? I’m not sticking a needle in that big toe- let’s try some NSAIDS instead! I trust a little pattern recognition in my aging physician mind. BTW, you and your buds( John, VP etc.)-please keep up your great efforts. You’ll are important voices in trying to steer this profession in the right direction.
agree, keep it up
Thanks so much Walter. Don't you think as you go on, the things you anchor on early are more and more likely to be right? (I might just be trying to make myself feel better before I head to clinic...).
In Hand Surgery, our problem with language is nomenclature. I was in preop checking consent. I asked my patient which finger I was going to operate on. He said his index finger. I was puzzled. The consent indicated the long finger. I asked him to show me, and he gave me "the finger," i.e., his middle finger,
One day in clinic a mother complained that her daughter was "popping" in the middle of the night. Sorting out symptoms with this family was always a challenge because they seemed to dwell in an alternate universe.
So.....what did she mean? Don't just leave us dangling that way!