I see far too much mental laziness in medical practice these days. I will give some examples below.To teach the residents mindfulness in diagnostics and therapeutics, I used to tell them to mind their P's and C's:
- Problem: What is the major malfunction that we are dealing with?
- Proof: Do we have proof of the problem or diagnosis? Is there uncertainty, or are there other possibilities?
- Cause: How did this problem come to be? Why is this happening? Is there a deeper cause? An even deeper one?
- Cure: What interventions should be employed to treat the problem(s) identified?
Sometimes I receive a call from the ER to admit a patient and the "presentation" if you would call it that amounts to rattling off a list of the laboratory abnormalities. "What is the problem?" I ask. "He's going to have to come in," is the reply. No, my friend, moving the patient out of the ED is YOUR problem. I'm asking what is the PATIENT'S problem. You are here, after all, to serve the patient, right? Some ERs appear to be evolving into glorified triage centers, with a primary focus on differentiating those who can be sent home, flown out, or admitted, rather than centers focused on making expedient and prompt provisional diagnoses so that time sensitive therapies can be administered post haste.
