How do neurologists make decisions?

I have often wondered about the fate of those patients that I see once or twice and then who seem to vanish into the wilderness. I have occasionally seen some of these patients at a shopping centre or walking down the street, and I must admit to a sense of relief that they are ambulant, functioning and not appearing terribly disabled. However, these patients are in the minority. In most cases, you either see a patient at regular intervals or you just never see them again.

So, what happens to these patients? Well, given how busy clinical practice can become, doctors don’t have the time and possibly the energy to think about all those patients who got away. May be they are fine, perhaps they are not and decided to look elsewhere for a solution to their problem. In any case, you don’t really know if you got it right or if you got it wrong. Personally, I am sure that I make many mistakes and that sometimes these are inconsequential and therefore overlooked by patients, while at other times perhaps they do result in some distress for the patient. The issue for me is feedback from my colleagues. I would love to know how and why I got something wrong as that is the only way to improve. But from my personal experience I know that it is difficult to tell a colleague that he/she got the diagnosis wrong, unless they have specifically requested your opinion regarding a patient. So, without knowing what happened you really can’t work on getting better at what you do.

In this JNNP podcast, we hear from Professor Martin Samuels (1). He is a highly distinguished neurologist from Harvard. He talks to Professor Huw Morris on clinical decision making, the ‘benefits’ of making mistakes and apologising to patients when you get it wrong.

  1. https://soundcloud.com/bmjpodcasts/how-neurologists-think-what-my-errors-taught-me?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+pn%2Fpodcasts+%28Latest+from+PN+podcasts%29&g=w_jnnp_podcasts_sidetab) .

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