Effective Diagnosis Begins with Good Story, Says Joshua Kosowsky, MD, at Concordia Books & Coffee
Nov. 20, 2013: Doctor and patient have the same goal in mind--to arrive at the correct diagnosis. According to Joshua Kosowsky, MD, co-author with Dr. Leana Wen of the book When Doctors Don’t Listen: How To Avoid Misdiagnoses and Unnecessary Tests, the first step on the journey toward reaching that goal is a good story.
Dr. Kosowsky, clinical director of the emergency department at Brigham and Women's Hospital and assistant professor of emergency medicine at Harvard University, spoke at Concordia College's Books & Coffee event on November 14 about the challenges both doctors and patients face in today's health care delivery environment. He offered ways to make some positive changes.
According to Dr. Kosowsky, a good diagnosis is based on a story effectively told and listened to. Heavy daily caseloads, however, along with related paperwork and administrative duties, have limited the time available to doctors to interact with patients. Patients are often subject to a bombardment of questions to gather data that, in an attempt to save time, doctors apply to algorithms, or formulas, designed to arrive at a diagnosis.
"Perhaps the only way we can get doctors grounded again is to empower patients to empower their doctors," Dr. Kosowsky said. The problem, he added, is not that doctors don't receive training in listening to patients, it's that in the real world of medical practice, patients and their stories often become a secondary priority to the other daily work required of doctors.
Dr. Kosowsky describes a diagnosis as a journey rather than a destination, a practice that leads patient and doctor toward a better understanding of what is really going on with a patient. "In order to figure that out, you're going to need some kind of story to lead you on one path or another," he said. "Doctors need to work with patients to understand their story and get to the diagnosis."
Storytelling is an art, Dr. Kosowsky noted, and all good stories have a beginning, middle, and end. All good stories have a trajectory designed to get to the point. These factors are especially important to remember, since the doctor will probably interrupt the patient's story to ask questions within 18 seconds of the patient's beginning to speak.
Dr. Kosowsky urged patients to know all the facts of their symptoms and histories and to practice their stories many times before they actually need a doctor and especially before an emergency arises.
"We all hope that health care reform will bring us to a better place," Dr. Kosowsky said, "but this is something we can all do at the ground floor when we go to our doctor. Every health care provider can be engaged."
Pictured here: Dr. Joshua Kosowsky speaking at Concordia's Books & Coffee event on November 14.
Photo by Carol P. Bartold
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