“I have completed my initial evaluation of your father’s fatigue. Based on history and my examination, this could be due to malnutrition; indolent infection or some hormonal imbalance. I have seen cases of depression or early stage dementia presenting like this. Worst case scenario; cancer can present this way too”, says Dr. Realdoc.

The son was not happy to hear the last sentence and says angrily , “You are wrong. He is not depressed and for sure he does not have cancer. Dr. PCP has never mentioned it and he is seeing my father for more than ten years.”

Doctor then explained to the caring son how the systematic approach towards a diagnosis works. Son said that he would like to discuss with other physicians. A fortnight later they agreed to run the tests to filter out the diffferentials.

Today was the day of reckoning. Quite unfortunately, the patient was suffering from end stage pancreatic cancer. Son was in shock then blamed his father for smoking and then rembered how long he had ignored the issue while using herbal medicine to help his father’s fatigue and how he wasted time before tests could be run. He was angry at Dr. PCP as well. Dr. Realdoc reassured him that such a cancer presents very late and probably was already spread when patient developed the symptoms. What would happen next is irrelevant here.

I hope that reader would be able to see different components of above true life example and will find similarities with any given problem.

Since the dawn of consciousness ; humans have been tackling problems; there are issues to take care of in present times and there are going to be obstacles ahead.

Obvious first best move forward is to learn from past experiences and apply on present issues. You will see that it won’t be that obvious to many people. Either they had no knowledge of Past and/or were told an altered version of past and/or they just don’t want to face the reality for their own vested interests.
i.e. They smoke!

Then are the more difficult tasks. The ability to detect the disturbance in your present and the next best possible move. Detecting a change would be easy for someone who had been paying attention to details since the time they deciphered the existence of consciousness. It will ironically be easy for someone who is anxious about every single thing without having the ability to get to the bottom of the reasons for disturbance in the norm. i.e. If you are feeling fatigued for no apparent reason then seek medical opinion.

Your next best move is to find a reason for the mysterious change. A recognition of the actual problem! You should devise a system which can identify all the possible reasons for the said change. In the absence of ability to do so would be a key to failure. The system should be unbiased; to the point; ruthlessly and comprehensive. Remember that such a system would attract a lot of hatred and criticism because of the nature of its job. It will brought to surface many unpleasant possibilities. Also keep in mind that unpleasant does not mean that those realities would cease to exist. If you are in denial or you want to repress then it’s your fault and you won’t be able to reach at the right conclusion. Based on those possibilities that system identifies; it should also suggest the path towards the most likely reason for the change. i.e. A doctor who is able to think about various possible differential diagnosis is better than the one who just focus on common ones. In above example , Dr. PCP never thought of cancer as possible reason for fatigue while that turned out to be the problem all along.

That is realdoc’s way to reach at a conclusion. He repeats this exercise every day; multiple times and it becomes his second nature. Yes ; he will not be successful every time but his approach is still excellent. Hostility that he receives for his honest evaluation is uncalled for. The system is not an enemy! It is blunt and honest attempt at unmasking the mystery.

Once the problem is identified then it is just a matter of time before it will get fixed.

Summary:

How a Doctor Solves a Problem

A doctor's job is to diagnose and treat patients who have various health problems. But how does a doctor approach a problem and find the best solution?

One way is to use a systematic method that involves four steps:

1. Identify the problem. The doctor listens to the patient's history and symptoms, and examines the patient physically and mentally. The doctor tries to find out what is wrong with the patient and what is causing the problem.
2. Generate possible causes. The doctor thinks of all the potential reasons for the problem, based on the patient's condition, risk factors, and medical knowledge. These are called differential diagnoses, and they range from common to rare, and from mild to serious.
3. Test the hypotheses. The doctor orders tests and investigations to confirm or rule out the possible causes. The tests may include blood tests, imaging studies, biopsies, or other procedures. The doctor interprets the results and compares them with the hypotheses.
4. Reach a conclusion. The doctor decides on the most likely cause of the problem, based on the evidence and logic. The doctor then explains the diagnosis to the patient and discusses the treatment options and prognosis.

This method is not foolproof, and sometimes the doctor may face challenges or uncertainties along the way. However, it is a rational and effective way to solve a problem and help a patient.

A doctor who uses this method is more likely to find the right solution than a doctor who relies on intuition or assumptions. A doctor who uses this method also shows respect and honesty to the patient, even if the diagnosis is unpleasant or difficult to accept.

By,
Dr. Muhammad Waqas