Tuesday, March 20, 2012
STEP 1: Overbook your patients: Schedule so many patients each day that you cannot possibly spend ample time with them or see them back for timely follow-ups. This step is not essential, but doing so allows the next steps to occur more easily.
STEP 2: Do not take a thorough history: Although a patient’s history usually provides essential clues to properly conceptualize cases, ignoring important aspects of the history such as family medical/psychiatric history, personal psychiatric history, history of substance abuse, and history of trauma helps get the interviews done faster so you can move on to the next patient. These topics are the easiest to discard because they are the most uncomfortable to discuss, despite the potential value they provide in understanding the current patient presentation. Do not obtain the patient’s medical records because this takes too much time as opposed to only relying on self-report.
STEP 3: Do not use any objective criteria for diagnosis: The diagnostic process is much faster and easier when relying purely on clinical intuition as opposed to a combination of intuition with objective diagnostic criteria. Doing so requires no standard and allows you to diagnose all sorts of conditions purely because you say so. This step also allows you to make up your own name for some medical conditions.
STEP 4: Prescribe unproven treatments: With no solid foundation for a proper diagnosis, you are now ready to move on to the step which involves prescribing medications, therapies, and use of various medical devices and techniques that have little to no scientifically validated evidence to support their use. If a proven treatment is available, ignore that and use the unproven one.
STEP 5: Do not coordinate care with other medical providers: If your patient is followed by multiple physicians, make no attempt to account for the patient’s numerous medications and the ways in which taking one can interfere with another or cause various adverse reactions.
STEP 6: Make no attempt to objectively measure treatment progress: Once the treatment is selected, keep it ongoing indefinitely and do not use objective measures it to check if it is successful. Simply rely on patient self-report and maintain the same general treatment approach if symptoms are still endorsed. Having no criteria for discharge is a bonus here.
STEP 7: Never alter case conceptualization: Once an initial diagnosis is settled upon (see step 3) do not alter it even if symptoms are reported indefinitely. Do not try to gather new information to figure out why this is happening but if new information arises, simply ignore it if it does not comport with the original diagnosis. Continue with the prior steps.
STEP 8: Do not refer to specialists: Since you already know the diagnosis and proper treatment, do not send the patient for evaluation by a specialist for a second opinion. This is the worst thing you can do because it may lead to an altered case conceptualization or different treatment approach. This is especially true if the specialist uses objective scientific approaches to patient care. The only exception to this rule is if you know of a specialist(s) who always agrees with you.
STEP 9: Make no attempt to measure symptom validity: Trust all subjective symptoms as accurate and make no attempt to measure (or refer to someone who can measure) symptom under-reporting or over-reporting in cases where the context would indicate it is appropriate to do so. Thus, if a patient has a severe medical problem but denies significant symptoms and wants to be released for certain activities, do this without considering reasons for why this may be the case (e.g., poor insight in a possible dementia case; desire to be normal again). Similarly, if a patient suffered a mild medical problem but reports severe symptoms grossly disproportionate to the event, make no attempt to assess for (or refer to someone who can assess for) why this may be the case (e.g., exaggeration to obtain medication and/or compensation benefits).
STEP 10: Do not keep up with the scientific literature or just ignore it: This step allows you to remain unaware of new scientific developments and maintain one’s accustomed way of doing things. If you become aware of research that suggests you should consider a different diagnostic and treatment approach, ignore it and continue with the old approach.
Posted by MedFriendly at 12:45 AM