History and Philosophy of Science at Oregon State University

by Rachel St. Clair*

Looking out on a large crowd in La Selles Center, Lisa Sanders understood that she had an attentive audience.  Sanders, who is known for her work on the television show “House” as both a producer and inspiration, came to Oregon State to discuss the theory of diagnosis.  Her March 13 lecture, “Every Patient Tells a Story,” focused on the importance for patient narrations of symptoms in the doctors office.

Her lecture began with the personal story of her own encounters with patients in medical school.  During her third year, she found herself lost in a Medical Mystery—a real-life Sherlock Holmes situation—where she tried to diagnose a patient by hearing the story of their symptoms.  She fell in love with diagnosis, which she claimed had previously been a simple ‘one-liner’.  She flippantly remarked that she had always been told to talk with the patient to “establish a relationship between doctor and patient.” Yet had never learned that this relationship could help the process of curing the patient.  She then made her overall claim that diagnosis is a triangular relationship.  The patient tells the doctor a story, the doctor interprets it into the diagnosis and then the doctor returns the story in form of diagnosis.  So why is it so hard to get in a sentence at the Doctors office?

She explained that doctors are under the assumption that time is limited when dealing with patients.  With many statistics, Sanders proved that patients speak, on average, around 23 seconds before a doctor interrupts them. Even more astonishing, that only 2 % of these patients boldly continue on telling the story once interrupted.  So patients feel cut off, but what about the doctors?  They need to make sure a patient doesn’t just ramble on for hours.  Again, Sanders showed data (from medical journals) that if a patient is allowed to tell their entire story, they speak on average of a minute.  This means that the doctor would spend just one extra minute per-patient, to save himself time in diagnosis.  To push her point further, Sanders then showed the number of correctly made diagnoses after each step of the medical examination.  The doctor would make the correct diagnosis after the patient story over 50% of the time while after either a physical exam or medical test, the doctor would only make a correct diagnosis less than 10% of the time.  So doctors will be successful in the first attempt at diagnosis, saving them more time than they spent to hear the patient story.

As a historian, I believed Sanders’s lecture to be ahistorical.  By claiming that diagnosis was a one-liner, Sanders literally made me shake my head in frustration.  Diagnosis, with or without a patient story, is influenced by so much more than a single doctor’s opinion.  They typically desire the help of nurses, pathologists, and other doctors in trying to make up a decision about diagnosis.  For example, Sanders had explained that her first impression of the mystery of diagnosis came in a resident report meeting.  This is a collective discussion about all the symptoms of a patient and the residents try to diagnosis the disease.  This environment of communication sounds, to me anyway, more than a ‘one-liner.’  Also, past diagnosis has been transformed from something mystical into something technical.  Sanders may have a worthy claim in saying that doctors need to listen to their patient, she does not, however, try to develop any deeper meaning about what this process of diagnosis does for medicine in general.  Sanders is a pragmatist, looking to help the patient understand what they have, but not commenting further on how this would benefit medicine.

*Rachel St. Clair is pursuing a Ph.D. in History of Science at Oregon State University.