When Stumped for a Diagnosis, Examine the Patient!

The new issue of The Lancet tells a story of a woman with a stubborn cough, unrelieved by standard treatments and no closer to a diagnosis even after extensive testing. When someone finally examined the whole patient, she turned out to have an obvious breast cancer. The cough, it turned out, was caused by pulmonary lymphangitic carcinomatosis.

The authors propose the term “McCoy’s Syndrome”, after the physician in Star Trek. He relied solely on technology to diagnose his patients. We should not, the authors say:

“Unfortunately, McCoy’s syndrome seems to be widespread in the health system at the moment, striking mainly doctors, but also other health-care professionals and even patients. The most characteristic feature of the syndrome is the excessive faith in medical technology, particularly imaging. Other components that might also be present are the absence of clinical reasoning and of establishing emotional links with sick people. Some cases also show incapacity to think about common diagnostic hypotheses, particularly in university hospital environments.”

McCoy’s syndrome: a new medical entity : The Lancet.

One Comment to “When Stumped for a Diagnosis, Examine the Patient!”

  1. I have been harangued by patients to have an MRI so that they can know if their ACL is torn.
    I respond – “I examined it, it’s not.”
    They say, “How can you tell without seeing an image?”
    All data is dative, in the linguistic sense – it has no existence without something to which it can be subservient, to which it can contribute as a handmaiden. Data is not the queen; it is the servant.
    “My fork” is a phrase with little meaning. “I stabbed the guy who stole my Jell-o WITH A FORK,” now, it adds meaning to that sentence. A knee MRI is as meaningless as a fork. What it allows one to understand, is the thing that is valid.

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