The new face of Midlife Health; Improving diagnosis and finding support

"How Doctors Think" and using social networks for your health

By the time we reach middle age we have the health care system down flat. Wait an hour for a 15-minute visit consisting of a cursory exam, a snap diagnosis and then a written prescription. This is the system. The bad news is that their is very little you can do to change it on a macro level. The good news is that you can change how you experience it yourself.

Step one is to demystify the medical world and most importantly gain an understanding of the process of diagnosis which is probably the single most important factor in becoming healthy. The fact that you are reading a midlife health story on the Internet puts you in a good position to move forward toward improved medical experiences. An excellent tool in this process is Jerome Groopman's book How Doctors Think.

According to a WSJ review of the book:

...diagnosis often yields an accurate guess about the cause of a malady, thereby laying the groundwork for its cure. Diagnosis is the starting point of medicine, and it begins, as Dr. Groopman tells us, the moment a doctor sees a patient. Within a few seconds of coming face-to-face, most physicians are already forming an idea of what's wrong, gauging skin tone, breathing, posture, tics, energy level and a variety of other physical cues. With a few glances and a quick scan of the chart, they begin to move toward a diagnosis before a word is spoken.

The conversation that happens next -- the "tell me what's wrong" talk between doctor and patient -- is the heart of Dr. Groopman's book. "How a doctor thinks," Dr. Groopman writes, "can first be discerned by how he speaks and how he listens." It is here that you can tell what sort of doctor you've got. And it is here that things sometimes go awry. Dr. Groopman cites the observation that within an average of 12 seconds most physicians interrupt their patients' stories, cutting them off or redirecting their comments and often leading them toward what the doctors already think is the most likely diagnosis.

Once physicians take their first steps down this diagnostic path, the rest of the conversation and later tests tend to hew to it as information is tailored in subtle ways to support what has become a foregone conclusion. In the meantime, other possible reasons for the patients' complaints tend to be ignored or sidestepped. This is the fast track to diagnosis -- and it is often right. Unfortunately, as the author notes, that's not always the case.

Publisher's Weekly noted that "Other errors occur when a patient is irreversibly classified with a particular syndrome: 'diagnosis momentum, like a boulder rolling down a mountain, gains enough force to crush anything in its way.'"

Sound familiar?

My own experiences with a bad back mirrored this process. I went from doctor to doctor receiving different explanations for the numbness I was experiencing in one of my legs. MRI's and x-rays were inconclusive. I finally made it to a spine specialist who "diagnosed" me within just a minute of first hearing my story and moved to schedule me for an epidural--a somewhat involved and expensive process. As I started to ask him detailed questions he referred me to his website which, as it turned out, had the answers to every one of my questions. However I still had an unsettling feeling about the speed at which the diagnosis was made and the lack of interest he had in even hearing all of my symptoms.

Had I had the chance to have read "How Doctors Think" I would have seen that this experience is far from unique as well as what I might have done differently for communicating with my doctor and improving my changes for successful care.

Another positive development is the rise of social networks focused on health. Social networks can easily conjure up images of teens chatting about music, fashion and homework (MySpace, Facebook, etc.) but the very same tools that make them an indispensable part of a teen's social life are making them useful for understanding and dealing with health issues.

Traditional health-oriented Internet websites and message boards have generally lacked the ability to filter out spam and abusive comments. Just about anybody could post and they typically didn't have the tools for community members to easily differentiate between valid and non-valid content. Social networks, however, by their very nature have the ability for the community to self-regulate such behavior, rank content, as well as allow users to have different conversations and create special relationships. To be certain it is still very early days for health-oriented social networks but even such traditional health organizations such as the CDC are using new social media tools like Second Life.

In addition to social network there are now podcasts, blogs, and customized search engines for just about every type of personal health issue. Once you have a diagnosis from your medical professional there is simply no shortage of resources to turn to for information to supplement what your doctor tells you.

In short, you can optimize your health care experience by doing the following:

1. Get the best doctor available to you. Expect appropriate "best side manner" in addition to proper medical skills.
2. When possible, schedule a visit at your doctor's least busy time.
3. Prepare in advance how you are going to explain your symptoms.
4. Respectfully challenge them if they make too quick of a diagnosis--knowing that odds are they are correct in their assessment. However due to the importance of the initial diagnosis, it's in your best interests to ask questions.
5. Ask them what will happen next in your condition and what it will mean if something else happens.
6. Take notes.
7. Research. Not to replace what your doctor says but to help you make informed questions for them.