HealthWACH: When doctors don't listen



The cost of health care is skyrocketing; $2.7 trillion spent on health care, 18 cents of every dollar, with up to a third of medical costs wasted. However, the problem goes much deeper than cost. More than 100,000 Americans die from medical error every year, while the majority of errors are attributed to mistakes in diagnosis. Every day patients are going undiagnosed or misdiagnosed despite doctorsâ?? increasing reliance on tests. Patients feel out of control and out of touch with their own health. Dr. Lena Wen and Dr. Joshua Kosowsky are two ER physicians who started noticing their patients becoming increasingly frustrated at getting more tests, but fewer answers, which led them to write the book When Doctorâ??s Donâ??t Listen. So, to rebuild the patient/doctor relationship they say to follow their eight pillars to better diagnosis.


  • Tell your whole story. Studies show that more than 80 percent of diagnosis can be made based on history alone. So learn to tell an effective story and prepare it for the next doctor visit.

  • Assert yourself in the doctorâ??s thought process. Find out what the doctor is thinking as you recount your history, and let the doctor know what is on your mind.

  • Participate in your physical exam. Donâ??t be afraid to ask about the implications of any findings.

  • Make a differential diagnosis together. â??Differential diagnosisâ?? means to just have a list of all the possible diagnoses that could explain symptoms.

  • Partner in the decision-making process. Devise a strategy with the doctor for narrowing down the list of possible diagnoses. By pairing up with the doctor, a working diagnosis without tests is often achieved.

  • Apply tests rationally. If a test is needed, then understanding how a particular test works will narrow down the risks and alternatives.

  • Use common sense. A patient should not leave until they understand what the diagnosis is. Donâ??t just assume the doctor must be right.

Integrate diagnosis into the healing process. Talk through the diagnosis with the doctor and make sure to understand its predicted course