‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics
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Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics
#2The title was too long, so I took off the quote marks.
'So why didn’t you think this baby was ill?' Decision-making in acute paediatrics
I'm submitting this because people on HN are interested in cognitive bias, and this paper discusses biases in the context of healthcare.
Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics
#3Much attention (because Taleb) is given to "having skin in the game" - and rightly so. It's an important and actionable heuristic.
Also of tremendous import is "gut feeling" which is called out specifically in the article:
"Gut feeling has been defined as an intuitive feeling that something was wrong even if the clinician was unsure why."
The disorganized, indescribable, cumulative knowledge of a human practitioner who has seen thousands of cases is so valuable that it should be given very particular nomenclature and afforded tremendous esteem - even more so than the physicians with their decades of schooling.
Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics
#4As a non medical professional, I can't even imagine the difficulty in trying to diagnose a severely sick child that is too young to speak or articular symptoms/where it hurts... Scary.
Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics
#5This hits close to home for me. My 3 year old daughter was recently diagnosed with a rare form of cancer (with a rather poor prognosis).
We brought her to a pediatritian in two states, both thought it was nothing but "growing pains". Her limp got worse, she was in incredible pain for days. She would develop fevers with no other symptoms.
She would mysteriously get better, then a month later it would happen again. Each time it got worse and her pain increased, the limping was more pronounced.
They misdiagnosed her and wanted us to see a specialist for it. We refused to wait a couple months to get an appointment with one and demanded to see someone, anyone else.
We eventually got to see a doctor (not a pediatritian) that at least done their done and ordered proper tests. Unfortunately they found bone lesions. Upon closer inspection they found a primary tumor in her abdomen, the cancer has already spread to her bone marrow (hence the bone pain/lesions and limping).
She's doing pretty good now-- still along ways to go for treatment though.
All in all-- as a parent you need to follow your gut and don't trust everything doctors say or feel. We lost a few months due to poor pediatricians that couldn't do their job (these were pediatricians at well known places).
Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics
#6This hits close to home for me. My 3 year old daughter was recently diagnosed with a rare form of cancer (with a rather poor prognosis). We brought her to a pediatritian in two states, both thought it was nothing but "growing pains". Her limp got worse, she was in incredible pain for days. She would develop fevers with no other symptoms. She would mysteriously get better, then a month later it would happen again. Eac…
First, I'm sorry to hear about your daughter's diagnosis. I'm also sorry you and your daughter had to go through that experience in the first place. If you're comfortable, I'd love to hear more about your experience.
For example, what were your expectations going into the appointments with the first two pediatricians? What were you hoping they would do that they didn't? What did they miss that the eventual doctor got right? Did you and your daughter felt heard or ignored by all of them?
Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics
#7Much attention (because Taleb) is given to "having skin in the game" - and rightly so. It's an important and actionable heuristic. Also of tremendous import is "gut feeling" which is called out specifically in the article: "Gut feeling has been defined as an intuitive feeling that something was wrong even if the clinician was unsure why." The disorganized, indescribable, cumulative knowledge of a human practitioner w…
I work with a lot of physician colleagues (as well as veterinarians) and one of the things I wish we could capture was what words someone uses to trigger those gut feelings. The way a patient describes their pain, how we try to wrap our language around complex disease concepts...
Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics
#8> Physiological values are complex in paediatrics. They are more than complicated because although there are published ‘normal values’ which will guide the clinician in knowing whether a child is tachycardic or tachypnoeic, these are in fact reference ranges that were initially based on expert opinion. Although meta-analysis shows these reference ranges to be at least somewhat valid, it is probably safest not to think of them as ‘normal ranges’ at all since much of the data includes children in abnormal circumstances. Indeed, the clinician who relies on these values will by definition be unlikely to have a ‘normal’ child in front of them.
Relatedly, I'd imagine that (akin to the story about choosing what parts of a fighter plane to armour) the worst health emergencies, esp. in children, are the ones where the child does not make it to the ER alive or is either unresuscitable (word?) or deteriorates rapidly and uncontrollably before a diagnosis can be made.
Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics
#9As a non medical professional, I can't even imagine the difficulty in trying to diagnose a severely sick child that is too young to speak or articular symptoms/where it hurts... Scary.
One of the things my veterinarian colleagues talk about a lot is how do you make a diagnosis with "My chicken is acting funny" as the only information you have.
Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics
#10This hits close to home for me. My 3 year old daughter was recently diagnosed with a rare form of cancer (with a rather poor prognosis). We brought her to a pediatritian in two states, both thought it was nothing but "growing pains". Her limp got worse, she was in incredible pain for days. She would develop fevers with no other symptoms. She would mysteriously get better, then a month later it would happen again. Eac…
Not pediatrics, but I had hand issues and went to a handful of doctors over the couse of two years who dismissed me after poking or prodding my hands a couple times.
AFAICT there's no way to _know_ a doctor has experience and wisdom, but it's crazy that doctors won't even order relevant tests done. It's not a matter of costs - all they need to do is ask first.
In the end I went to the Mayo clinic in Minnesota where they performed a thorough battery of tests and gave me a proper diagnosis within a couple days. If you're at your wits end, at least I can recommend them as being diligent.