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When the Art of Medicine
Seems More Like a Puzzle

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed on page 31 in the May 15, 2013 and Jan. 4, 2012 issues of
The Mississauga News under the feature: Health & Beauty, Medicine Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

Medicine is as much an art as it is a science. The ability to examine a situation or a person, and use technology to help sort through that process is a skill that takes time and thought. In medicine, we doctors use terms such as TESTS and RESULTS, and this confuses patients.

The result of a test is not always the answer to a patient's problem. When I arrange certain testing on a patient, the outcome is called a result, but in reality it should be called a CLUE. The art of medicine is the ability to look at all the clues and formulate a DIAGNOSIS.

The terminology can strain the doctor-patient relationship. Patients sometimes show up asking for us to procure and copy results of tests conducted in other settings for their own use. To them, the term "result' is exactly that, the answer to their problem. Some results are simply numbers generated by a machine, others are color reaction to dyes, and many others are opinions of my colleagues of a picture or slide.

Sometimes, it belittles the physician-patient relationship because doctors feel that the patient is questioning the quality of their work. They don't realize that the terminology has set off a wild goose chase. Heart EKG's are a common example. The machine in my local lab stamps an interpretation on the print-out that is often wrong. A patient who copies this raw data may suffer undue anxiety. I will look at the same print out and come to a different conclusion.

X-rays are another example. An x-ray report is the opinion of a radiologist of a picture taken by a machine and combined with a few sparse words written by the ordering physician. The radiologist does not always have the luxury of examining the patient as I do. When I don't understand the "result', I speak to my colleague or look at the raw picture myself and not the written opinion. Patients sometimes want a copy of the report so they can get a second opinion on an opinion. Not a wise choice. It reminds me of the guy at the car garage who stands next to the mechanic and wants to know what every bolt does.

Everyone experiences frustration with the poor transfer of medical information that occurs at times. A significant problem that we face on a regular basis is the arrival of normal looking data from unsolicited sources. It can only be compared to buying a used jig-saw puzzle. You have no way of knowing if all the required pieces are there, and what compelled someone to tackle it in the first place. Sometimes this is followed by a message from a patient who would like me to complete the puzzle without the benefit of the box top containing the picture. Anxiety gets the best of them, and they ask for explanations why someone else assembled the pieces in a particular order. There are as many ways of putting a puzzle together as there are pieces. Try it some time. It makes little sense to spend time staring at one tree when you are searching for a forest.

Related resources:

Article: How a Diagnosis Works by Dr. Jerry Gordon, Dental Comfort Zone.

Sapira's Art & Science of Bedside Diagnosis by Jane M. Orient, MD (ed.) [Book Review].

The Art of Knowing Through - Diagnosis, the Heart of the Medical Art from Greek Medicine. The word "diagnosis" comes from the Greek, and literally means, "knowing through". Diagnosis is the ability to see through the often bewildering maze of manifest signs and symptoms to arrive at a sure and certain knowledge or conclusion as to their root cause, or what is really going on.

Medical diagnosis from Wikipedia.

The Art of Diagnosis: "True Medical Detective Stories' from Health Beat by Maggie Mahar.

The "Art' of Clinical Decision-Making. Published by Harriet Hall under General, Science and Medicine, from Science-Based Medicine. Note: Harriet A. Hall, MD, is a retired family physician and former Air Force flight surgeon.

Automated Medical Diagnosis based on Decision Theory and Learning from Cases by Magnus Stensmo (Computer Science Division, University of California) and Terrence J. Sejnowski (Computational Neurobiology Lab, The Salk Institute, La Jolla, CA).

Pitfalls of Online Medical Diagnosis from Right Diagnosis.

Self Diagnosis Pitfalls from Right Diagnosis.

Pulse Reading: The Miraculous Art & Science of Diagnosis from Amrita Veda.

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