Doctors are the mostly highly trained professionals in the world and still make diagnostic errors. What was the key step that allowed the doctor's to save Crystal's life? In light of the introduction, what might you do in the future to ensure doctors made the correct diagnosis and course of treatment? Or do you just trust the process and allow doctors to occasionally make mistakes?
Please respond to this post before class on Thursday, March 17th.
The key step that allowed the doctor to save Crystal’s life was his thoroughly going over each symptom and not, as the others had been doing, focusing on her bloody diarrhea as the main problem. He considered every part of the case and was able to determine that her red blood cells were being lost not externally but internally, and from there he connected her symptoms to liver failure and, luckily, had sufficient knowledge to identify her disease as Wilson’s Disease. By listening to her whole story and delving deeper than simply the charts and other doctors’ accounts of her illness, he was able to paint a more comprehensive picture of her case and thereby come up with the correct diagnosis.
ReplyDeleteAs a patient, if I ever found myself in a situation of having an unrecognizable/undiagnosed disease I would definitely be sure to present as much information about it as possible, knowing that seemingly unrelated events or circumstances might be the connecting puzzle piece enabling a successful diagnosis that could mean the difference between life and death.
On the whole, however, I do trust doctors. The occasional mistake may happen, but it’s certainly comforting to know that there are a plethora of professionals available for help. What one doctor misses may well be caught by another, as shown by the story of Crystal. By no means am I entirely naïve and utterly trusting of the system, because error is inherent in human nature, but I do think that a collaborative process between doctors and patients can be effective in coming up with a successful diagnosis.
After countless tests, the doctors could not figure out what was wrong with the patient. However, the doctor who put all the pieces together and saved her life, had only to ask the patient to retell her story. The doctor made sure not to read the test results lest his judgment get clouded by other people's diagnoses.
ReplyDeleteI feel that doctors should show just a little more patience when listening to their patients instead of switching directly to running tests. Sometimes, just listening to their story can help shed light on some of the most obscure test results. Thus, talk to patients.
The key step that allowed Walerstein to correctly diagnose Crystal’s illness and save her life was starting the diagnosis on a clean slate, eliminating any assumptions or leaps in conclusions that previous doctors had made. Because Walerstein weighed all the symptoms and was able to figure out which had more importance or pertinence to Crystal’s specific case, he was able to see a clear connection to a rare case of liver failure, suggesting that the tests showing no significant problems in liver cells was actually the result of a “dead” liver. While the doctors were frantically trying to figure out Crystal’s illness by paying too much attention to specific details, Walerstein was able to succeed in finding the problem by taking one step back and examining the situation as a whole, with every aspect in view. Clearly, the other doctors were missing something, and in identifying that a continuation of the same methods of searching would not work to reach the goal, Walerstein was able to find a new method that eventually did unlock the mystery of Crystal’s problem.
ReplyDeleteFirstly, the more diagnoses doctors study, the more knowledgeable and prepared doctors will be in saving people’s lives. As stated in the introduction, a considerable number of patients die due to misdiagnoses. More knowledge would clearly create an advantage in the medical world. However, no doctor can diagnose every disease and disorder, especially since new rare conditions are constantly being added to this huge wealth of knowledge we have. In these cases, doctors should be sure to look at every test and detail of the patient’s background, creating a solid foundation of information to piece together. Doctors should also not focus too much on a single detail, especially if that detail proves to be only a marginal issue that will not help in the process of diagnosis.
Although doctors save many lives, they still need too pay utmost attention to diagnosing patients correctly because this step is the most important in identifying and treating the patient’s illness. I think that patients do need to establish a certain amount of trust with their doctors, but as we can see in Crystal’s case, such trust is not always the most promising. In any case, I think doctors should strive to perfect their methods and knowledge in the diagnosis process, and although they will make mistakes, more attention will always lead to significantly positive results, affecting both physicians and patients alike.
Well, if I've learned anything from watching many episodes of house, it's hard to diagnose a patient and therefor that doctors make incorrect diagnoses all the time. In Crystal's case, the main inhibitor of a successful diagnosis was the ignorance and rarity of her genetic disorder. Sarah, if she had known that she had wilson's disease, she probably would not have taken antibiotics in the first place, and at least the dentist wouldn't have proscribed them. It was the ignorance of this condition that basically caused it in the first place, because the consumption of antibiotics is what set of the liver time bomb. The rarity of this condition contributed to the lack of diagnosis and therefor the prolonging of the condition itself. If Wilson's disease was more common, more doctors would have known about it, recognize the symptoms as Wilson's disease, and prescribe a cure. The key in this diagnosis was the fact that one doctor did recognize the symptoms and did have a knowledge on the condition. The only way to avoid occurrences such as this one is to have more doctors be more educated on more subjects. However this is unrealistic because when you train doctors in more breadth, you sacrifice depth which would make doctors less efficient in each individual diagnosis.
ReplyDeleteThough many doctors examined Crystal, her life-saving diagnosis could only be reached when a doctor stepped back from individual symptoms and past tests, and examined her symptoms cohesively. Originally the doctors were studying a single symptom, such as her anemia, at a time. The one who was able to make the diagnosis stepped back from these individual expressions and viewed Crystal as an entire, integrated system. Another factor that was key to making a correct diagnosis for Crystal was the original doctor referring his case to others. There is simply too much information for one doctor to master, so it is crucial that they ask others for assistance in diagnosis. Other doctors may pick up on symptoms, see things in a fresh way, or just recall a certain disease.
ReplyDeleteIf I was ever faced with a severe medical problem, I would try to be sure to both explain the story fully and seek a second opinion. So much of diagnosis seems to be reliant on what the patient can relay about symptoms and previous events, that I would try to present the full story to be sure that a doctor would not examine a single symptom alone. I would also ask for a second opinion because there is simply so much medical information available, no doctor could possibly know it all. Another diagnostician may pick up on clues that the other did not notice, or at the least could confirm any data or conclusions reached. If however my medical problem was not severe, I would be much more accepting of any diagnostic mistakes. As the author stated, it is incredibly costly and time-consuming to examine every patient for small ailments such as a sore throat. If I had such a problem, I would allow a doctor a primary diagnosis and wait to see if my symptoms were alleviated before trying anything more drastic. Overall however, I think that doctors need to be very careful in making diagnoses, to be sure that no information is overlooked or disregarded.
As others have said, the key step was connecting all of Crystal's symptoms to liver failure, and taking a more holistic view of her illness.
ReplyDeleteIn Crystal's case, it was a combination of the patient initially not being listened to enough, and the rarity of her actual condition, which led to the difficulty with which she was diagnosed. Her multitude of symptoms were confusing, and clearly different doctors interpreted them differently. Because each doctor brings their own perspective and bias to their medical practice, maybe the most successful way to do diagnose patients with complicated issues is Dr. House's method: to assemble a team to diagnose the patient cooperatively, with each member bringing a unique background and skill set to the table.
Doctors are human, and they make mistakes. This should definitely be accounted for. But to ensure that doctors can do the best job they can, it is the responsibility of every patient to provide the clearest possible history of their health. Additionally, if more cooperation and less competition were fostered amongst doctors (and even medical students), the welfare of patients would most likely be more emphasized than personal medical reputation.
The key step that allowed the doctor to diagnose Crystal's condition was to take a step back from the jumble of data about her health and focus carefully on the story of her condition and on actually observing her physical condition as a whole. However, this step would not have been enough to arrive at a correct diagnosis if it wasn't for the doctor's significant medical knowledge and, perhaps even more so, his willingness and ability to collaborate with other doctors.
ReplyDeleteI definitely agree with Jlor that it's really important for doctors to actually listen to patients and avoid treating them merely as collections of data and test results. Taking a step back to find a unified solution to the various symptoms a patient is facing seems like the reasonable thing to do, since the systems of the human body obviously interact with each other in complex ways.
One thing that might help doctors diagnose patients more accurately is to make the conditions under which they examine and treat patients less frenetic, allowing for more careful thought. At the same time, since no doctor can have an encyclopedic knowledge of every disease, doctors should be trained in a way that emphasizes careful collaboration, and taught that there is no shame in not knowing the answer as long as you consult other doctors who can fill in the gap in your knowledge in order to help the patient. Even though the art of diagnosis will never be perfect, it would help if doctors communicated better with one another and with their patients.
The step that I think made the most difference in correctly diagnosing the young girl's rare and strange disorder was the doctor's decision to go to a more experienced doctor, a mentor or a friend to help him. I think that collaboration and the pooling of ideas is extremely important in getting the correct diagnosis. The actual key step was when Walerstein made the logical leap that there was something else behind the data about the patient that was causing the wide range of illnesses.
ReplyDeleteIt is difficult to make sure that the doctors get your diagnosis right. By its very nature, diagnosing patients is an extremely difficult part of being a doctor. Sometimes doctors will make mistakes. Just because they are highly trained does not make them omniscient. I am looking forward to reading this book even more after reading the intro.
The doctor was able to save Crystal's life by not being overwhelmed by the appearingly severe bloody diaherria (among other symptoms), and evaluated and judged each symptom independently, allowing the doctor to make a balanced diagnosis. By determining the interior loss of blood cells, rather than through external discharge, Crystal's doctor investigated her sickness through in depth investigation.
ReplyDeleteI know my doctor well, and I believe that he is a blanced individual that can make a proper diagnosis. However, in light of what I have read so far, I believe that a doctor should not overlook a probable diagnosis merely due to the rarity of a disease.
The key step Dr. Wagoner made was to contact other doctors. Wagoner himself knew that the diagnosis (Clostridium difficile) did not fit all of the symptoms Crystal exhibited. Therefore, Wagoner did the best thing he could do, consult his mentors, and have them consult theirs. Basically, Wagoner knew that he was unable, despite his medical training, to find the real reason why Crystal was dying. Unlike the other doctors, who focused too much on one symptom or another, trying to find one condition at a time, Wagoner knew that Crystal’s diagnosis should not exclude ANY symptoms. Sure enough, Dr. Walerstein had the knowledge of this particular disease, and was able to cure Crystal within one night through a liver transplant.
ReplyDeleteIn the future, all doctors should avoid basing his/her diagnoses on only a fraction of the symptoms. Every doctor knows that a condition is only fully diagnosed when all of the symptoms are explained by the condition. Doctors should not compensate by rushing through someone’s symptoms in order to find a temporary or partial solution. All doctors should know that a disease is caused by very specific problems, and a diagnosis should take into account all those problems. In addition, it’s obvious from the vast knowledge of medicine that one cannot learn everything in medicine. Specialists can only contribute so much to a diagnosis. The future of medicine needs more Wagoner’s who are willing to step forward and ask others for help, potentially to find the Walerstein’s out there to know a vague condition (Wilson’s disease).
Personally, I am very skeptical of modern doctor’s ability to diagnose patients. While Doctor’s are only human, and make mistakes, they are also prone to pride. Why did no one in the diagnostic group for Crystal (but Wagoner) realize they needed help? The medical community needs to be more open to fix its problems in diagnostic medicine. The only way to get a good diagnosis is if everyone agrees (and even then it may not be right!).
Might I also mention that Crystal’s EXACT case was featured in a House episode, solved in the same way as Walerstein by Dr. House through an ophthalmologist.
The key step that allowed doctor's to save Crystal's life was when the more experienced doctor went to Crystal and listened to her explanation of what happened, and then looked at her charts without looking at the notes added by other doctors. This allowed him to take an isolated point of view, as opposed to being swayed by the ideas of doctor's around him. When he stepped back from all the tests and opinions of other doctors he was able to figure out the real problem.
ReplyDeleteIn the future I think it is important for all doctors to look at patients in this way. To take a step back, and look at a situation using only your knowledge. Also, going to others that are more educated in a certain field is also important.
I think the there were several key steps taken by Dr. Walerstein that allowed him to correctly diagnose the patient: his ability to discover that the liver was the fundamental cause of the illness, his careful examination of the patient’s history, his cohesive view of all her symptoms, and his knowledge of the rare disease that plagued her. It was all of these important discoveries that lead to his discovery of Crystal’s illness. In the course of Crystal’s treatment, doctors unintentionally took several missteps, which all contributed to a misdiagnosis. It is unfortunate, but the medical diagnosis process is riddled with possible error - doctors miss tiny but crucial details, test results can be misleading, and causes can be difficult to find.
ReplyDeleteI think it is important for there to be as many doctors on a case, or able to be consulted, as possible. This will decrease the chance of a detail slipping through the cracks, and increase the knowledge available for finding a diagnosis. I also think it is crucial to take a complete patient history, as a fact from his/her past could prove essential to the correct diagnosis. Also, doctors should be hesitant to prescribe a treatment, such as antibiotics, to a patient if they are unsure of the diagnosis. In the case of Crystal, the rushed decision to pump antibiotics into her system made her condition so much worse. Some error is inevitable, but it is important for hospitals, and doctors, to take all possible precautions.
As many others have said it seems that the key step that allowed the doctor to save crystals life was his ability to come into the diagnosis by disregarding the pervious doctors notes and observations. The doctor was able to come into the situation with a clean slate and make a diagnosis based on listening to the patients story rather than rigorously searching for a diagnosis by re-reading the other doctors notes or studying the tests that had been taken. he did not search for answers there. the doctor was able to integrate the patents story with his medical knowledge in order to come to the correct conclusion and diagnosis.
ReplyDeletei think this plays an imperative role in being a successful doctor. you must integrate both your medical knowledge and your ability to listen and take in. you must think that no diagnosis is too obscure and that everything is possible. You must come into the situation with an open mind that will accept the patients story with full credibility and significance and also an open mind with the way i which to treat this, or the possible diagnosis of the illness.
I think that the key step that allowed the doctors save Crystal's life was approaching her in a different way. He actively decided not to look at her chart which allowed him to block out insignificant or irrelevant symptoms. It allowed him to focus on what was killing Crystal rather than what that then caused. I think that this is very important in the medical field. People are always asking what is causing a symptom rather than thinking on a broader spectrum. I think that this book is basically the literary version of HOUSE which is awesome because that show rocks!
ReplyDeleteI think in the future, the AHRQ and other health services can train doctors and offer grants, but in reality, there is no real way to stop a misdiagnosis. I think that it was mostly luck that Walerstein recognized the symptoms from a random disease that doesn't usually have these symptoms. I am not saying that he isn't a talented doctor, just that it is impossible for every doctor to know every single fact in Gray's Anatomy or every single medical fact in general. I think that doctors make mistakes and that is natural for all humans and there is nothing we can do about that.
What I found most interesting about this was that none of the doctors seemed to find it very important that THEY be the ones to actually find the diagnosis. Their only real concern was the find what was wrong with this young woman and to save her life. Also, to be able to look at the symptoms objectively and with a fresh eye, even after countless doctors had already made in depth notes and observations seemed crucial to this. It is difficult to rule something out 100% and only by not doing this did they finally find a way to save her.
ReplyDeleteI think that the key step in the process to diagnosing Crystal was to hear the story and know all the symptoms, even those that had been tossed aside at the beginning because they didn't make sense. When there are symptoms like that, doctors should not disregard them. Instead, they should pay at least as much attention to those symptoms as to those they know how to explain, if not more. As far as I know, extra complications in a problem that make no sense are not often simple errors; they often are clues to a completely different problem.
ReplyDeleteOf course, it was also a very lucky coincidence that the doctor who knew to look at all the symptoms also knew the disease that they were pointing to. A single doctor, even one who knows to consider all of a patient's symptoms, still might not know everything they need to know to diagnose their patient. It seems to me that it would be impossible for one doctor to know every possible disease, so I guess the next best thing is to have a large network of doctors whose knowledge covers enough to be able to diagnose and treat most patients. Luckily, this was the case and the doctor who diagnosed Crystal was part of this network.
Even after dozens of doctors had examined Crystal, none had a clue to what was killing her. The doctors had collected the story from the patient of the progression of her disease, taken numerous tests and examinations yet still couldn't piece together the story. The doctors were baffled by the variety of Crystal's symptoms and the speed in which they appeared - she was healthy only days before. Dr. Walerstein was eventually contacted and called in to see Crystal. Walerstein took an approach which should be celebrated, which was to piece together the story for himself instead of reading Crystal's chart and following in the other doctors' misleading footsteps. Walerstein happened to focus in on the right symptoms and ask the right questions such as, could it be possible that the blood tests weren't detecting a liver failure because the liver had already been completely destroyed? And could this destroyed liver be the cause of Crystal's blood loss and the red blood cells were being destroyed within the body instead? Walerstein diagnosed Crystal with Wilson's disease, a rare, inherited illness in which the liver is unable to regulate the copper mineral. In Crystal's case, the antibiotics she had taken for a root canal had triggered the copper blast from the liver, destroying the liver and the red blood cells as stored minerals from the liver flood into the bloodstream. Crystal was cured with an immediate liver transplant.
ReplyDeleteIt really amazed me how Lisa Sanders argues that the process of making a diagnosis often goes unnoticed in the practice of medicine. As a potential patient, I have always assumed that the diagnosis is the most important factor in treating a disease - that only after a diagnosis is made, the proper medicine can be prescribed and the symptoms of the disease treated. Sanders however makes the argument that doctors often have only a clue at what is the cause of the patient's illness, and will make preliminary prescriptions and recommendations, embarking on a trial-and-error type process. I have previously considered the potential inaccuracy of doctors, especially when I saw no obvious benefit come from the medicine they prescribed; however, after reading Sanders' argument I agree that the best way to confront illnesses is to piece together the puzzle a little at a time, which could mean starting out with a potentially incorrect prescription in order to gain more information. I can only hope that all doctors approach their work like Walerstein and make an meticulous effort to figure out each individual patients story, instead of relying on preconceived ideas of what is wrong. I have always been suspicious that a doctor, when hearing the patient tell his story and explain what uncomfort he feels, is waiting for just one symptom that the doctor is comfortable with and has easily dealt with before. This focus on one symptom could paper over the true root cause of the problem, especially if the wrong symptom is given the most attention.
Despite multiple doctors, blood tests and imaging studies, Crystal’s diagnosis was elusive until Dr Walerstein came to the picture. Dr Walerstein was an old-fashioned doctor with wealth of knowledge and experience. What was unique about Dr Walerstein was that he treated his patient with his heart. He had independent thinking. Instead of cutting corners by reading other people’s entries, he went to the bedside and took the history himself. He thought through the case logically and refused to jump to conclusions if the facts did not fit. He was able to identify discrepancies in the workup. Instead of getting lost in expensive blood tests and fancy imaging, Dr Walerstein resorted to the fundamentals of medicine-a good history and physical examination. His good physical examination led him to the discovery of a big liver leading to possibility of copper deposit in the liver. Interesting, the diagnosis was ultimately made by another finding i.e. deposit of copper in the eye . In sum, Crystal’s diagnosis was made by thorough history and physical examination. In medicine,as in other professions, human errors are inevitable. To minimize errors in medicine, there should be a process in place to make sure the doctors are adequately trained. Of course, the knowledge comes with experience. The doctors should be assessed periodically to make sure they have not lagged behind. Finally, the medical communities should have a process to review misdiagnosed or mismanaged cases taking action against incompetent doctors.
ReplyDeleteI think the key step the doctor took in diagnosing Crystal was, instead of approaching Crystal's charts before approaching her, the doctor took the time to talk to the patient and inspect her carefully, before turning to the raw data. Many doctors got stuck on the data--every new doctor that looked at it would simply come to a similar conclusion to the previous doctor, because they were all looking at the same data with the same bias. It is essential doctors are able to approach a patient with a fresh mind; if not, there will be no way for unconventional diagnoses to arrive.
ReplyDeleteTo this extent, I think that it is imperative that there is full disclosure between a patient and a doctor. Occasionally, the patient may screen what they disclose to a doctor, either for personal reasons or simply out of believing that a symptom/event is irrelevant. This is not the patient's role to play--the patient should disclose everything, so that the doctor is able to sift through the minuscule details to come to a conclusion. Furthermore, with the network of doctors that was discussed, it is easier for small details to be caught by one doctor, that perhaps were missed by another. In this sense, each person brings a bit of their own medical experience to a diagnosis, so that as they work together, they are able to shed light on various possibilities and emphasize the importance of previously overlooked symptoms.
After extensive and unsuccessful research regarding Crystal’s symptoms, Dr. Walerstein was able to diagnose Crystal’s unique case as Wilson’s disease. In this particular case, I believe that the doctor was able to diagnose Crystal because of his attention to the patient’s story as well as attention to the seemingly insignificant details of the patient’s symptoms. Because Dr. Walerstein’s work in the case followed the work of several other doctors, he was able to use the information of other doctors as well as his own individual knowledge in discovering the reason for Crystal's mysterious symptoms. As the author Lisa Sanders states in Every Patient Tells a Story, “no one can know everything” (xxv). Although each doctor is limited in the general amount of information he/she has, when many doctors work together, their different ranges of knowledge can support and benefit the case. In Crystal’s case, Dr. Walerstein was eventually able to diagnose her because he had the advantage of his fellow doctors’ knowledge as well as his own unique information (regarding Wilson’s disease in this case). Not only does Dr. Walerstein have a broad array of information from his colleagues, but he also attains a different perspective from the patient herself. With this large compilation of knowledge, Dr. Walerstein was finally able to solve the diagnosis.
ReplyDeleteIn the future, I believe it would be helpful for doctors to acquire a larger range of information before making a diagnosis. Because the human mind is limited and not one person can know everything in the field of medicine, the involvement of several doctor’s on a single case is beneficial to finding an accurate diagnosis.
The doctor who was trying to find out a way to help crystal succeeded where the other doctors could not because he took the time to listen to her story and put together details that the other overlooked when giving her a diagnosis. He looked at the data with an unbiased eye and by making the connection between her lover failure and red cell blood destruction he was able to diagnose Crystal with Wilson's disease. In the future if I am ever in such a situation, I think the best way that i can help the doctors help me is to disclose all my stories and let them know what happened to me without leaving anything out so that they can be aware of certain details that may seem insignificant but might end up saving my life. I would also be aware of diagnosis and medicines that doctors try to describe to me. I would want to just trust the process because a small mistake can lead to the end of my life.
ReplyDeleteCrystal’s case was one that baffled doctors and persisted through a string of tests before a diagnosis was reached. Her rapidly declining health and abundance of symptoms seemed to overwhelm Dr. Manis and Dr. Wagoner. After taking antibiotics following a dental operation, she came to experience achiness, fatigue, fevers, and bloody diarrhea. Tests showed that she had a high white blood cell count, an extraordinarily low red blood cell count, and dysfunctional kidneys and clotting system. So, where does one start in his quest to solve Crystal’s case? It seems that to be as comprehensive as possible, all plausible diagnoses must be reviewed. Unlike others, Dr. Walerstein did not focus on the bloody diarrhea, but instead honed in on the fact that she could not form blood clots. Ultimately, Walerstein was able to reach the conclusion that the disease destroyed Crystal’s liver before she even reached the hospital, invalidating the test that proved she did not have liver damage. Liver failure and red blood cell destruction led to the diagnosis that she was suffering from Wilson’s disease. The key step saved Crystal’s life was Walerstein’s questioning the information that other doctors simply understood to be undeniably true.
ReplyDeleteThe question Lisa Sanders poses is a thought-provoking one. Why could the other doctors not successfully diagnose the patient? I am no doctor, but if there’s one lesson to be learned from Crystal’s diagnosis, it’s to be creative. Dr. Walerstein initially stay away from Crystal’s medical chart to avoid being influenced or misled by the thoughts of others. In other words, he wanted to keep a wider and more flexible scope.
There isn’t much we can do to ensure doctors make the correct diagnosis. As they are the most professional in the field, the only ones who are qualified to ensure a doctor made the correct diagnosis are other doctors themselves. In Crystal’s case, there didn’t appear to be any incorrect diagnoses, just incorrect hypotheses. Wagoner and Manis certainly did not misdiagnose Crystal; rather, they simply couldn’t figure out what she had, so they resorted to going along with the idea that Crystal had C. diff. They also contacted Walerstein for help. Manis and Wagoner did, indeed, administer the incorrect course of treatment, but they may have calculated the risks involved in doing so to be minimal.
As many people have previously stated, a crucial component to Dr. Walerstein's eventual success was that he was able to utilize previous doctors' knowledge and research about the case. With both a broader view of the situation (because he could reference other doctors' perspectives) and his own specialized info, Dr. Walerstein was able to amass enough knowledge to finally solve the case at hand. I believe this collaboration is crucial to the success of doctors because having a wider array of perspectives and knowledge diminished the risk of a wrong diagnosis; two heads are better than one. What one doctor may miss, another may catch, or if one doctor zeroes in on an unimportant symptom, there are other doctors to research the rest of the case. Having a well equipped team of doctors minimizes the risk of potentially fatal mistakes in the process of reaching a diagnosis. It is also extremely important to for the doctor to listen to the patient and for the patient to fully disclose their perspective so that the doctor can be able to consider the whole story; all details - even those that are seemingly insignificant - can and should be factored into the situation.
ReplyDeleteCrystal’s case was one that baffled doctors and persisted through a string of tests before it could be solved. Crystal’s rapidly declining health and abundance of symptoms seemed to overwhelm Dr. Manis and Dr. Wagoner. After taking antibiotics following a dental operation, she came to experience achiness, fatigue, fevers, and bloody diarrhea. Tests showed that she had a high white blood cell count, an extraordinarily low red blood cell count, and dysfunctional kidneys and clotting system. So, where does one start in his quest to solve Crystal’s case? It seems that to be as comprehensive as possible, all plausible solutions must be reviewed. Dr. Walerstein did not focus on the bloody diarrhea, but instead honed in on the fact that she could not form blood clots. Ultimately, Walerstein was able to reach the conclusion that the disease destroyed Crystal’s liver before she even reached the hospital, invalidating the test that proved she did not have liver damage. Red blood cell destruction and liver failure pointed towards Wilson’s disease. The key step to saving Crystal’s life was the questioning of previous information that other doctors had misguidedly accepted to be true.
ReplyDeleteThe question Lisa Sanders poses is a thought-provoking one. Why could the other doctors not successfully diagnose the patient? I am no doctor, but if there’s one lesson to be learned from Crystal’s diagnosis, it’s to be creative. Dr. Walerstein initially stayed away from Crystal’s medical chart to avoid being influenced or misled by the thoughts of others. In other words, he wanted to keep a wider and more flexible scope. I’d like to think that there are severable viable approaches to finding a correct diagnosis. Wagoner and Manis were certainly not wrong in the way they approached matters; they just couldn’t fit the pieces together as Walerstein had. Technically, there were no incorrect diagnoses, just incorrect hypotheses. Wagoner and Manis made the decision to approach the Head of the Department of Medicine, one that helped save Crystal’s life. Although Manis put the patient on an incorrect treatment course, he seemed to have done so while at least somewhat cognizant of the fact that she may not have had the supposed infection to begin with. However, he also may have calculated the risk involved in putting Crystal on the wrong treatment to be minimal, making it “safe” to do so.
I don’t think there is much we can do to ensure that doctors make the correct decisions in diagnoses. The most qualified people to make sure that a diagnosis or treatment is correct are other doctors themselves. Making a diagnosis is not a straightforward black-and-white process. If it were so, then we could devise high-powered machines to do all the legwork. Obviously, this is not the case, and because we are human, we are prone to errors. The process conducted by Wagoner, Manis, and Walerstein doesn’t seem to be atypical: a couple doctors had trouble reaching a diagnosis, and reached out to a more experienced one who eventually succeeded. The patient ultimately survived.
I think the there were several key steps taken by Dr. Walerstein that allowed him to correctly diagnose the patient: his ability to discover that the liver was the fundamental cause of the illness, his careful examination of the patient’s history, his cohesive view of all her symptoms, and his knowledge of the rare disease that plagued her. It was all of these important discoveries that lead to his discovery of Crystal’s illness. In the course of Crystal’s treatment, doctors unintentionally took several missteps, which all contributed to a misdiagnosis. It is unfortunate, but the medical diagnosis process is riddled with possible error - doctors miss tiny but crucial details, test results can be misleading, and causes can be difficult to find.
ReplyDeleteI think it is important for there to be as many doctors on a case, or able to be consulted, as possible. This will decrease the chance of a detail slipping through the cracks, and increase the knowledge available for finding a diagnosis. I also think it is crucial to take a complete patient history, as a fact from his/her past could prove essential to the correct diagnosis. Also, doctors should be hesitant to prescribe a treatment, such as antibiotics, to a patient if they are unsure of the diagnosis. In the case of Crystal, the rushed decision to pump antibiotics into her system made her condition so much worse. Some error is inevitable, but it is important for hospitals, and doctors, to take all possible precautions.
I think that the key step Dr. Walerstein took in understanding Crystal's illness was his willingness to go over her history and look at all the symptoms she had, instead of just looking at what other doctors thought about her. Instead of ordering a battery of tests and looking at what might possibly be abnormal, he listened to her story of what was wrong with her and did a thorough examination before even thinking about the results of any tests. As the author points out, every patient is unique, and might not follow the normal pattern of an illness; Dr. Walerstein looked at Crystal as a person with an illness, not just as a list of symptoms in a chart or in a medical textbook.
ReplyDeleteHowever, Dr. Walerstein was only able to make the correct diagnosis of Crystal because he had prior knowledge of her disease. Doctors make mistakes all the time, and oftentimes it's just because of simple human error or because it's impossible for one doctor to know every single symptom and every possible cause. Sometime's it comes down to guesswork, and there's not much we can do to change that. The medical profession could become more collaborative, especially with the use of the internet, but it's hard to rule out human error from the medical profession, and we need to trust doctors to do the best they can.
Though many doctors had puzzled over the true reason behind Crystal's symptoms, Dr. Walerstein's approach was successful because he made all of his own observations, only using the test results and work made by others to strengthen his diagnosis. Most importantly, Dr. Walerstein focused on aspects of Crystal's case that had not previously been given much speculation. After asking her to recall all of her symptoms and the story of how they had progressed, he performed a physical checkup on her and noticed that she had an inflamed liver. He then referred back to the information gathered by other doctors, which told him that Crystal could not form blood clots. This fact, combined with the inflamed liver symptom, suggested liver failure. Dr. Walerstein came to the conclusion that Crystal was suffering from the genetically inherited Wilson's Disease, which explained all of Crystal's mysterious symptoms. Dr. Walerstein made a breakthrough in diagnosing Crystal because he had made all of his own observations and speculations. While other doctors had scrounged for answers amidst the test results and work done by others, Dr. Walerstein was not influenced by the findings of others and instead used their research to supplement his own theories as to what was wrong with her.
ReplyDeleteI think that it is imperative for doctors who are faced with such difficult cases, as that of Crystal's, to not rush into diagnoses, especially if what they conclude does not completely explain the symptoms of the patient. What was more scary than the fact that doctors could not figure out the cause of Crystal's illness was the thought that doctors wanted to settle with an incorrect diagnosis that would do nothing to hinder Crystal's progression towards death. For this reason, I believe that doctors should be sure that they have taken into account all aspects of an illness before diagnosing, to ensure that every symptom has been accounted for.
Argh! I posted before but it didn't show up.
ReplyDeleteThe doctor was finally able to diagnose and then treat Crystal's illness by taking a step back from the jumble of data and symptoms to examine her overall, and also by consulting with other doctors to help him figure out the case. Although doctors will always end up making mistakes, no matter how highly they are trained, I think there are some ways that medical errors could be reduced. One way would be to do thorough physical exams of patients whose diagnosis is a mystery. Based on the introduction, it seems like doctors sometimes become confused by looking at mazes of inconclusive test results and don't always examine the patient as closely as they should. Another way to reduce errors would be to emphasize the importance of collaboration in medical treatment, and to make it clear that doctors should always be willing to ask for help or advice if they don't know what they're doing. That seems like an easier solution to the lack of knowledge about rare conditions than making doctors memorize more arcane diagnoses.
The key that allowed Walerstein to make his diagnosis was the fact that he investigated the case without initially looking at Crystal's chart. Thus it makes sense that he was able to make a correct diagnosis when so many before him failed. True, part of it was because he just happened to know about the rare Wilson's disease, but, putting that aside, he knew that if he were to read her chart before hearing her story, he might become tainted with the thoughts of the previous doctors. I have experienced this myself; if you're trying to solve a problem no one before you has, you mustn't try to follow in their footsteps, lest you hit the same dead end. Instead, you must try to figure it out on your own. Luckily, Walerstein did this exact thing.
ReplyDeleteI suppose this would make me want to be completely open with the doctors, perhaps tell them stuff that wouldn't necessarily be related, just to make sure the doctor is completely informed (I notice on House it's usually these little revelations that often solve the case). Other than that, I just assume doctors can and do make mistakes, and we just have to live with the margin of error.