Benny Binion once said, “Trust everyone, but always cut the cards.”
Over the past 10 years I have done ward attending as my sole clinical activity. I average around 150 days a year making rounds. As time goes on, I become more skeptical of any information that I do not collect myself.
People I do not trust:
- The ER physician
- The outpatient record
- The outside hospital
- The resident
- The intern
- The student
- My colleagues
- Myself!
I trust no one. Too often patients are “billed” as having a certain diagnosis, but the true diagnosis is quite difference. All the people I listed are honorable and doing their best. But patients change over time. The attending physician ALWAYS gets a more accurate history the next day. The physical exam changes and becomes more clear.
The worst thing I can do is to accept everything at face value. Many patients have straightforward diagnoses, but enough are tricky, that I must always assume that I should rethink the presentation.
We all make mistakes. We must second guess ourselves daily. Our patients deserve no less from us. We should be persistent in our search for truth.
Many mystery novels use this as a technique. They seem to finalize a resolution, but the stubborn detective insists that the data do not all fit just right. That is our job. Keep thinking; remain skeptical; when in doubt go back to the bedside, talk to the patient and examine the patient. Remaining skeptical is the best way to minimize diagnostic errors.
