Lessons in clinical reasoning – pitfalls, myths, and pearls: a case of persistent dysphagia and patient partnership

Yumi Otaka; Yukinori Harada; Andrew Olson; Takuya Aoki; Taro Shimizu

doi:10.1515/dx-2024-0061

Article

Lessons in clinical reasoning – pitfalls, myths, and pearls: a case of persistent dysphagia and patient partnership

Yumi Otaka , Yukinori Harada , Andrew Olson , Takuya Aoki and Taro Shimizu

Published/Copyright: September 3, 2024

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From the journal Diagnosis Volume 11 Issue 4

Abstract

Objectives

Diagnostic excellence underscores the patient-centered diagnosis and patient engagement in the diagnostic process. In contrast to a patient-centered diagnosis, a doctor-centered diagnosis with a lack of patient engagement may inhibit the diagnostic process due to the lack of responsibility, disrupted information, and increased effect of cognitive biases, particularly in a situation where multiple physicians are involved. In this paper, we suggest a promising idea to enhance patient engagement in the diagnostic process by using written information by a patient about their perspective and experience, which can fill the gaps needed for diagnosis that doctors cannot find alone.

Case presentation

A 38-year-old woman developed chest pain, which gradually worsened during the following two years. For two years, she was evaluated in multiple departments; however, no definitive diagnosis was made, and her condition did not improve. During this evaluation, she searched her symptoms and image findings online. She reached a possible diagnosis of ‘esophageal achalasia.’ Still, she could not tell her concerns to any physicians because she felt that her concerns were not correctly recognized, although she showed her notes that her symptoms were recorded. She finally consulted the department of internal medicine, where her notes and previous test results were thoroughly reviewed. The final diagnosis of esophageal achalasia was confirmed.

Conclusions

Doctors must organize an environment where patients can freely express their thoughts, emotions, and ideas regarding their diagnosis. Cogenerating visit notes using patient input through written communication can be a promising idea to facilitate patient engagement in the diagnostic process.

Keywords: esophageal achalasia; patient engagement; patient-centered diagnosis; diagnostic errors; diagnostic excellence; cognitive bias

Corresponding author: Yumi Otaka, MD, Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsugagun, Tochigi 321-0293, Japan, E-mail: o-yumi@dokkyomed.ac.jp

Research ethics: Not applicable.
Informed consent: Informed consent was obtained from the patient.
Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: The authors state no conflict of interest.
Research funding: None declared.
Data availability: Not applicable.

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Received: 2024-03-21

Accepted: 2024-07-29

Published Online: 2024-09-03

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Articles in the same Issue

https://doi.org/10.1515/dx-2024-0061

Keywords for this article

esophageal achalasia; patient engagement; patient-centered diagnosis; diagnostic errors; diagnostic excellence; cognitive bias