Why you need to play an active role in your fertility care

December 28, 2010Carole No Comments »

Our health care system is capable of great things but too often falls short on fulfilling its full potential for the end user – the patient. Especially in the reproductive field in the US, there is weak federal oversight, few professional standards and inconsistent state regulation to define what is the best medical practice for infertility diagnosis and treatment. In this environment, most of the burden of delivering the best health care falls squarely on the shoulders of the physician and some physicians are much better at diagnosis and treatment than others. That is why patients can’t afford to be passive, but need to be involved in their own care.

A case in point is the thorny problem of diagnosis. Diagnosis is difficult. You would think that with all our technology and tests, it would be the easiest thing in the world to determine the root cause of infertility. Sometimes test results are wrong and sometimes poor communication about lab results or patient history or symptoms can interfere with the correct diagnosis, leading to the wrong treatment. Sometimes the diagnosis is complex with several underlying issues. For instance,  an obvious structural problem (eg. blocked tubes) presents itself, but that may not be the only issue and identification of the first solution may blind your doctor to other conditions (eg. ovulatory dysfunction) that might also play a role.

In this American Medical News article  “Diagnostic errors: Why they happen”, Kevin B.O’Reilly describes the mental hurdles and obstacles that physicians must overcome to arrive at an accurate diagnosis. It is human nature to jump to the first diagnostic answer that presents itself, but sometimes this causes a kind of mental blindness- called an “anchoring bias”-  which blinds the physician to other solutions. A 2005 study of 100 diagnostic medical errors found that about a third were due to cognitive mistakes. Other causes identified in the study included delayed tests, malfunctioning equipment or a combination of cognitive and non-cognitive mistakes.

Copied from the O’Reilly article below, are a list of cognitive mistakes which were originally described in this primary source: “The importance of cognitive errors in diagnosis and strategies to minimize them,” Academic Medicine, August 2003 (www.ncbi.nlm.nih.gov/pubmed/12915363)

“Anchoring bias: Locking on to salient features in a patient’s initial presentation too early in the diagnostic process and failing to adjust in light of later information.

Availability bias: Judging things as being more likely if they readily come to mind; for example, a recent experience with a disease may increase the likelihood of it being diagnosed.

Confirmation bias: Looking for evidence to support a diagnosis rather than looking for evidence that might rebut it.

Diagnosis momentum: Allowing a diagnosis label that has been attached to a patient, even if only as a possibility, to gather steam so that other possibilities are wrongly excluded.

Overconfidence bias: Believing we know more than we do, and acting on incomplete information, intuitions and hunches.

Premature closure: Accepting a diagnosis before it has been fully verified.

Search-satisfying bias: Calling off a search once something is found.”

Physicians are human, like the rest of us, and prone to the same mistakes. That is fundamentally why patients must play an active role in their health care. This doesn’t mean bullying your doctor but it does mean asking him to explain his reasoning behind a diagnosis. His explanation may cause you to remember and be able to remind him of other symptoms or history that might be relevant to your diagnosis that would otherwise be overlooked. If both of you are working to diagnose a problem correctly, it seems to me that the odds of overlooking salient facts or jumping to conclusions prematurely may be lessened. A neighbor of mine is a medical malpractice attorney and she tells me that most of her cases are due to doctors having a bad day, not being bad actors. If you and your doctor are both actively involved in your infertility care, you might be able to help him avoid making diagnostic errors on his bad days.

© 2010, Carole. All rights reserved.

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