In late 2018, I was diagnosed with a life-threatening condition by a team of doctors from a renowned public hospital in Malaysia after just a single consultation. Up until that point, I have had symptoms for over 2 years, but was told by many doctors in the private sector that there was nothing wrong with me. Thankfully, I am out of the woods now. After months of treatment and recuperation, I am able to look back at that experience and learn from it. I am glad to share it with you.
It is important that healthcare providers listen emphatically to the patients they serve in order to arrive at the correct diagnosis. Listen with the intent to understand, not with the intent to reply (read more about emphatic listening and what Stephen R. Covey has to say about it here). Empathic listening allows healthcare providers to fully grasp the reasons for the patients’ presentations. It also helps healthcare providers gain insights into patients’ baseline states (what is normal to them) and then make comparisons to the patients’ presenting conditions.
Listen with the intent to understand, not with the intent to reply.
Stephen R. Covey
Often, healthcare providers are faced with patient encounters that do not make sense. These are the so-called “challenging cases”. Usually, in these cases, the examination/ investigation findings do not correlate with patients’ symptoms. A patient may have worrying symptoms, but nothing to show in the examinations and investigations. Does that mean that the patient is lying? Another patient may have worrying signs and investigation results but appears to be asymptomatic. Should we treat the patient on the basis of the investigation results alone?
The answers depend on the healthcare providers’ objective. Because healthcare providers’ objective is to treat patients (always), the first patient should be investigated further and then treated, while the second one should be observed for the development of symptoms. It is important that healthcare providers are able to see each clinical encounter with a clear and unwavering objective to treat. Based on my humble experience, healthcare providers who can see this objective clearly tend to do better and ultimately provide better patient experience.
Think Slowly (Defer Judgements)
If you are familiar with behavioural psychology and decision-making concept researched and written by Daniel Kahneman in his book “Thinking Fast and Slow”, you will know that in daily human interactions, our fast thinking (or what he calls System 1) dominates. It often leads us to make snap judgements and jump to conclusions even with limited information. And because fast thinking (System 1) requires less energy and effort, it becomes our default system. Clearly, this may create biased clinical judgement in the healthcare setting if it goes unchecked.
When people believe a conclusion is true, they are also very likely to believe arguments that appear to support it, even when these arguments are unsound.
Biased clinical judgements may result in misdiagnosis, late diagnosis, suboptimal care and poor patient experience. These must be avoided at all costs. Engage in deeper analysis and problem solving without being heavily influenced by heuristics or biases from System 1. Consciously ‘slow down’ thinking (evoke System 2) by actively deferring judgements. Although it requires a lot of effort, it will pay off. Most importantly, recognise when System 1 (fast thinking) is in operation and purposefully engage System 2 (slow thinking).
If you are a healthcare provider and would like to share your thoughts on this matter, please feel free to get in touch in the comment section below. I would be delighted to have other healthcare providers sharing their experiences here.