Every physician is familiar with the value of information from a single clue, which is sometimes the crucial hint that makes all the difference – the key to the kingdom. To that end, no fact should ever be overlooked, no evidence should ever be ignored, and no truth should ever be denied.
Yet physicians do ignore facts – all the time. After all, they are only human, and it is easy to overlook things. In the hospital setting, however, a fact that is ignored – leading to the wrong diagnosis and treatment, and then causing harm to the patient – will eventually have its day in the sun.
The ignored fact will rise like a phoenix, spread its wings, and display its colorful feathers for all to see. It will once and for all become the center of attention, the focus of analysis, and the heart of discussion of many brilliant, medical minds. Where else will this take place but at the monthly M&M Report, the final resting place of all vital, consequential, overlooked facts.
Yes, indeed, the failure to notice, accept, or otherwise acknowledge an important fact is the surest way to the podium at the M&M conference. And the most common way for a fact to be overlooked is for a physician to stubbornly stick to a hypothesis when contradictory evidence emerges. This particular cognitive error is so common, we have a name for it: anchoring.
The physician who anchors has become so attached to a presumptive diagnosis that he simply cannot accept a fact to the contrary. If possible, he will twist the truth around to make the new fact fit the original hypothesis, when instead he should be revising his theory to fit the new evidence.
From The Ailing Nation, Chapter Four: Diagnosis
If there is one thing that is drummed into physicians during their residency training, it is to never ignore facts. We do so at our patient’s peril. Accordingly, it is a rite of passage to become familiar with all the masses of information gathered for each patient – blood tests, EKGs, radiologic images, procedures, biopsies – and to incorporate every detail of those results into our assessment. Every deviation from normal must be accounted for and the best diagnosis will brilliantly tie up all the loose ends. Any piece that does not neatly fit into a space in the puzzle will eat away at us, day and night, until there is a satisfactory explanation. But what must never happen is to lose sight of an important fact or a single clue in the diagnostic investigation. This is the discipline of our profession: never to deny the truth. Can you imagine a political culture in which the truth may not be denied? If only.
