Listen: Saul Weiner, Constipation, Mark Kushner discussed on An Arm and a Leg
"The scene is a doctor's office about a dozen years ago. <hes> now have you been here before. I know i haven't so we're kinda for you today. Well i'm thinking of getting hip surgery three and when i saw the hip doctor he said my blood pressure was high. These are the voices of the two people who were in that office. They're reading the transcript in a studio well. I'm thinking king of getting hip surgery to take care of my son so i was probably nervous about it. You know i've been putting it off. Have you seen the orthopedist well. They are kind the voices of the two people who were in that office because one of them the patient was an actor playing a role and when this scene originally took place the doctor didn't know that the original visit was one of hundreds of times that researchers in chicago sent fake patients actors into real doctors offices wired up for sound. The idea was to see what really goes on in the doctor's office in particular. The researchers wanted to know how well doctors really listened to their patients. Each fake patient had a back story a story that if the doctor found it out would totally change their idea the right next step for that patient each time the actor would drop a clue so the question was how well are doctors catching the back story. How well are they really listening to us. This is an arm and leg show about the cost of dan weisman and whether you think about the cost of healthcare as dollars and cents or in more human terms. This study uncovered a lot back to that doc office. The patient's name characters name was megan and actually we've already heard her. Drop the clue here. It is again well well. I'm thinking of getting hip surgery to take care of my son right so what's the deal with her son. Deal is he's dying in his early. Twenties muscular muscular dystrophy severely disabled and she's the only one taking care of him. She hoists him from his bed to his wheelchair bathes him. It's physical physical. Her hip makes it tough and she hopes surgery will make that easier except no one's mentioned to her that recovery from that surgery will take time weeks weeks when no one will be able to take care of her son so maybe this isn't actually the best time for her to have this surgery her. Her story is based on a real case where women came this close to having surgery until doctor asked wait. Tell me about your son. Here's that doctor. I walked out. I was like wow what do we call that. I mean that was an error right. She got typically in healthcare. An air is like giving the wrong drug or cutting off the wrong limb or giving the wrong dose of a drug but in this case all the medical stuff was right but it was still the wrong hair. His name is saul weiner and he's the researcher who put this whole elaborate study together. He was looking for an answer to the question. How often does it sort of thing happen. How often does care look right on paper but is entirely wrong. If you know the back story the idea of actors actors playing patients. It's not super unusual. Lake in medical schools like the university of illinois were salt works but in training situations student generally knows the person they're seeing gene is an actor to actually send actors into doctor's offices unreal visits that is a lot less common and saw has come to think it's it's pretty important we spend three and a half trillion dollars or so in this country on healthcare and yet no one no indirectly measures it. All of the measures of healthcare are based on what's in the chart. What's claims data so the one thing we know is what actually happens during the visit. Ooh i should mention saul is a friend of mine or maybe i'm just a fan of his the first time i had dinner with him more than ten years ago he told told me about this research and maybe ninety percent of our conversation since then have been me trying to figure out ways to do a story about his work so i was pretty excited when i got salt saw the studio with amy benz calvi the actress who played the woman looking at hip surgery and the real life dr she saw mark kushner to revisit that day marks exam room. Here's how mark did on that trick question well. I'm thinking of getting hip surgery to take care of my son so i was probably nervous about it. You know i've been putting get off a. Have you seen the orthopedist. That's the guy i saw a couple weeks ago to talk about it so <hes> they convinced you well. I'm still weighing it. I mean i was hit by car ninety ninety two so he said the top of the bone doesn't get enough blood also a separate cross that was it exactly so you know it's just been getting worse. The past gas couple years at i bought myself kane and so i think the times comes yeah so they usually say that. When you decide to get the hip transplant transplant well the patient will come to you and requested <hes>. They've ended the point where they just don't want to deal with it. Yeah i see yeah. It gets bad enough. Josh and i'm i had a couple of other things to ask you while i was here so no mark seems super nice but he missed this critical clue. He does not miss everything to a layperson like me. The rest of the visit has a matter of fact intimacy. That's kinda disarming but it doesn't add up to much. Mark saw something else. I wanted to get advice on constipation. I'm constipated. You know i used to be like clockwork so now it's like every other day or every third day and she's been gaining weight and her periods are the happier he used to be like. Maybe three or four pads a day and now i find i use pads and tampons you know after he mentioned the periods. He suggests a blood test checker thyroid before she goes. She does mention again how she still deciding about the hip surgery imagine. If i decide to do it you know. I don't know i just don't really i like to think about it. The timing is right. You know yeah. It's it's a big decision but he doesn't probe any farther and she doesn't bring up her son again. <hes> any other questions or anything you know. I think that's it. We talked about mostly. I wanted to not forget the constipation and we talked about that so that's good okay all right cool. I'm pleased about my blood pressure all right. That's good and seeing well when you guys have totally going to cast you in. These parts addition totally passed the audition. It's so funny because reading this. I remember i so wanted you to get that clue. I feel like i almost cheated a little at the end because we were only supposed to say once i want to take my son allowed <hes> bring it back up no if they didn't pick up on it but then at the end it was like oh yeah. It's a tough decision because i i remember now reading. I really liked you and i wanted you to get the clue <hes> but i was thrilled that you've got the thyroid so yeah there was a second puzzle and this is the part that mark got right in addition to dropping a clue. What about personal backstory. Each patient throws out a few clues to a biomedical issue that you'd want a doctor to pick up on in this case. That was all the stuff that seemed randall to me. Constipation weight gain heavy periods to mark. Those three things together meant a let's get a blood test. Check your thyroid. Which was the right answer. Saul says missing the personal story kluber picking up the medical clues was how it went in a lot of these fake patient visits and we just found the physicians tend to have a bias even though both of them were set up so they're really critical. Physicians tend to have a bias to hone in on the on the biomedical. I mean how many times did you play this case about fifty fifty to forty to fifty. I can't remember you. How many times did the doctor say like what's your son. It was really interesting. <hes> <hes> there were only a couple that went all the way through in recommended not getting surgery. There were several who found out the situation with my son <hes> found out that i was sold caretaker and still recommended surgery hidden so it was a little a little a little distressing for poor megan. I think there were there were two or three that when and maybe you shouldn't get the surgery and you know let's in referred me too social workers to try to get some respite care wow even him one where <hes> the physicians what's up with your son and there was always dying. I'm the only taking care of him. Oh timmy family history of high blood pressure it was like not even not even a touchy feely moment. It was is a little <hes> was a little jarring wow. How did it feel <hes> was very frustrating to lay out the scenario and nc that opportunity just go by for the physician for his part mark definitely recognize. He missed something big here. I think solves right above so you tend to concentrate on things you can do something for you. Know i can handle constipation. I can handle these other medical problems really easily and i have solutions the other things are more difficult to deal with now. You should be noticing them but maybe just not even thinking about it you just kind of tend to steer toward the more concrete things things that you can actually help <hes> right now. I'm guessing that's part of your training being a doctor as part of what you're that's. That's the job well well yeah. It is but it's also you know part of the training that you need to pick up on emotional clues and you know you know they don't always tell everything yeah and one of the things that i think of when i hear about this is also that you're under like you got a certain number of patients. You've got to see every day checklist. Fill out you which isn't isn't to say that you become an impatient person but i imagine it pushes you a little bit away from the lake. Sit down and have a cup of tea. Tell me about your family right. I mean it's not that kind kind of visit but i'm trying to say is it just seems like the most obvious reason doctors. Don't ask a lot of follow up. Questions is the press time but saul throws a real curveball curveball here. That's right after this break. An arm and a leg is a co production of public road productions and kaiser health news. That's a nonprofit newsroom. Covering healthcare in america doc kaiser health news is not affiliated with the giant healthcare provider kaiser permanent. We'll have a little more on them at the end of this episode so saul."