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INsight | Differential Diagnosis

April 5, 2019

Dr. Nich King sits down with INsight to go over Differential Diagnosis.

Host: Welcome back. We’re here in the Sweeney Studios. I’m with Dr. Nich King. He’s a board-certified neurologist, who practices medicine and law. He does medical malpractice cases with the Sweeney Law Firm. When you were in medical school, you learned a diagnosis, a concept known as differential diagnosis. I need you to explain to me what that is.

Dr. King: Sure. So differential diagnosis is, in a nutshell, it’s basically all the potential diagnoses that you might consider for a given problem. So a patient comes in with say dizziness and a headache, and you might think through, what are the possible things that, that could be going wrong with this patient. It’s actually not too dissimilar from when you take your car in to the mechanic –

Host: Uh-huh.

Dr. King: -- and it’s clanking and you don’t know what’s going on, the mechanic has to try to figure out, Is it the brakes? Is it the transmission? It’s sort of the same idea with us. There’s not, usually, there’s not just one clear cut answer that’s just so obvious, so we have to go through this process of trying to figure out what could it be, and then how to narrow our field to determine what it actually is.

Host: So why is it taught to people, to students in medical school?

Dr. King: It is the foundation of making a true, good diagnosis. Because if you can’t formulate a good differential diagnosis, if you can’t formulate the five things or the three things or the ten things that this might be, then you’re potentially going to miss it. When we started medical school, all of us were tempted to just start ordering tests. You know, order a CDC, a chem set and an MRI and the, our instructor, instructors would teach us, think about why you’re ordering those tests. Come up with what you think the answer is and then, then try to figure out how to make that diagnosis, which is the way medicine is practiced in the United States.

Host: I, I feel like I know all those tests because of all the medical shows I watch on TV, so, you know, I’d be like, I feel like that’s what I would do, too. I’d just want to order all these things, but it, it’s essential, isn’t it, so that doctors don’t miss something, too?

Dr. King: Well, so we, we definitely need to order the right tests –

Host: And not the tests, so much as thinking through all the things it could be.

Dr. King: Right, exactly. Because if you ordered every test on every patient, the system would be bankrupt.

Host: Oh, dear heavens, no.

Dr. King: I mean, we obviously can’t do that.

Host: Yeah, yes.
Dr. King: So we have to use our judgment. We have to use our medical expertise to figure out what are the top three things or four things and, more importantly, what are the dangerous things that we need to rule out. Because if you’re going to miss a diagnosis, you better miss a diagnosis that’s not dangerous, --

Host: Uh-huh.

Dr. King: -- rather than something that is.

Host: So how does this differential diagnosis come into play when it comes to malpractice cases?

Dr. King: So we see this a lot in cases where a physician or a PA or even a nurse just doesn’t even think about what the actual diagnosis is. They list in their notes that they think, you know, this person who comes in with this, you know, complaint. They think maybe it’s this and, and they just put all their eggs in one basket. And if they don’t have the differential, then they do miss. I mean, we see cases where patients come in and the doctor did just completely miss the diagnosis because they didn’t even consider it.

Host: Give me some examples. In, in your years of experience in doing all of this, give me some examples of times where you’ve seen something’s been missed and it’s caused a problem.

Dr. King: So some of the scary ones that we’ve seen is patients who come in with maybe chest pain, shortness of breath, younger patients and they, they go to the doctor, they go to maybe an urgent visit center and they say, “Oh, you know, this is just a cold or it’s the flu,” and they just send them home. And they miss something serious, like a pulmonary embolism or a heart attack. And even a patient who’s young can have a heart attack, can have a pulmonary embolism, and if all the signs are there, then, and if you just write them off because you think this is just the flu or this is just a cold and I’m going to send them home, then you’re going to potentially miss that very dangerous diagnosis that could kill a patient, as opposed to missing something that maybe is a little more benign.

Host: So if somebody’s watching here today and they think, “Oh, my gosh, that happened to my love, my loved one. They went home, they died, they were 35 years old.” What do they do now? They say, “Oh, well, it happened a year ago. I just thought there was nothing I could do.” What do they do now?

Dr. King: They should call us and we would investigate that case. And if it seems like it’s a case where there was malpractice, where the doctor should have made the diagnosis, then that’s something that we would definitely pursue.

Host: Well, these are tragic incidents and we certainly hope and it, hope it hasn’t happened to anyone, but if it has happened to you, please give Sweeney Law Firm a call. Let them talk through it with you and see if it’s something they can help you with, or you can always visit them online, too, We’ll be right back.

Download the full transcript here.