History is 90% of diagnosis.
Labs are 10%.
CT scan is 5%.
Over all, wanting to be heard and understood is 50% of the reason your patient is sitting or lying there today.
The other half is “make me better.”
For any particular individual, those ratios vary from 99% to 1% and versa visa.
A few just want to know what they are dying of.
The other half is “make me better.”
For any particular individual, those ratios vary from 99% to 1% and versa visa.
A few just want to know what they are dying of.
The physical exam tells your patient to consider taking the treatment you suggest.
Except in dermatology where the physical exam is 90%.
The little skin autopsy makes the diagnosis in 75%.
The little skin autopsy makes the diagnosis in 75%.
Within the physical exam, 90% of the value is in the vital signs and general appearance.
Those two things alone can decide dc home v. admit. Or floor v. unit.
#realimportant
Those two things alone can decide dc home v. admit. Or floor v. unit.
#realimportant
More than half of all patients who will die this admission are “poor historians” with a “bad story” and “pan positive review of systems.”
Feeling like you’re going to die is hard to put into words.
It’s real different from other feelings that lend themselves to poetic description.
About 1/5th of patients you sent home with “nothing” will come back with “something.”’
Your mind tends to equate “I can’t find it” with “it’s not there.”
You only see the things you look for and you only recognize them if you already know them by name.
We usually find other doctors’ misses and they find ours.
So we both think the other guy is dumber than he is.
So we both think the other guy is dumber than he is.
Those are the facts of the practice of medicine. Thank you for your kind attention.
