Diagnosis vs. Understanding
I’ve been a long-time fan of the Diagnosis column in the New York Times Magazine, written by Dr. Lisa Sanders. Dr. Sanders writes about medical puzzles— cases that didn’t fit the script, or that represented rare diagnoses and required expert opinions, good luck, thinking hard, or all of the above. Unsurprisingly, she was a consultant on House, but the column is much more medically interesting. As a card-carrying medical nerd, I love piecing together the clinical data and thinking about the cases. What body system is affected? Is it infectious, autoimmune, environmental? Is there a rare condition with a matching illness script that I can unearth from school, or a case report I read once, or a podcast I listened to last week? What information would I want to get? and finally, what’s the diagnosis?? When I saw that Netflix made a documentary series, also called Diagnosis, with Dr. Sanders, I was All. In.
And it was great. But not in the way I expected. The series had mysteries, fascinating diagnoses, and a crowd-sourcing element that was effective and heartening. But by putting the patients and families at the center of the narrative, it shifted the focus from the medical minutia to the human experience. These were stories of people who were suffering, and the processes that did (or didn’t) get them help. Here’s the thing: healthcare providers mean well, by and large– yet so often, patients don’t feel that. They feel frustrated, and dismissed, and uncertain, and discouraged. On top of being sick. These aren’t puzzles, or cases. They’re people, and we in healthcare need to remember that. Even when we want to scream that the patient isn’t listening to reason, is convinced they have something they don’t have, or is being dramatic/uncooperative/noncompliant/whatever. We are not perfect. Our knowledge is limited, and our field of view is incomplete. The Diagnosis series is a great reminder of this.
While we’re talking about TV, there’s an episode of Crazy Ex-Girlfriend where the protagonist gets a diagnosis from her psychiatrist. Upon learning that she in fact has a diagnosis, and not just a bunch of problems, she is elated. She sings a song about it (my diagnooooosis. . . ). This is pretty ridiculous, but it captures something very important and often missing from medical narratives: the validation that comes from feeling understood and recognized is in and of itself therapeutic. For a healthcare provider, remembering that regardless of what diagnosis is or is not made, patients have feelings and thoughts about what happens to them, and they are valid, even if they don’t align with our ideas.
The question becomes, then, not just how can we improve diagnostic accuracy, but also how can we infuse the process with empathy? Can we learn to better hold and value others’s perspectives, emotions, experiences, thoughts— alongside other truths? Can we, in fact, hold space for multiple truths? Can we honor frustration and the search for answers even when we think something different? Can our science brain and our human compassion brain coexist?
[note: a version of this post appeared on the blog zabbylogica in February of 2020].
