I work in a hospital setting and I would say 90+% of the time the issue is diagnosed following a checklist for a particular problem. In the medical field we are taught to think of a 'Differential Diagnosis', or DDx for short, and sort by probability based on the history, age, sex, etc of the patient. Of course in the hospital setting you would also think of 'which of these issues can possibly kill my patient in the next 24hrs' and look for those as well.
So you go down your DDx list and if you run out of diagnoses, go back to the history/patient and think about it some more or consult with your peers.
As far as the "House MD" situations, i haven't run into any of those so i can't comment on that part.
I fully understand this point of view, and I think it's invaluable to have said checklists and DDx lists. Having tools like UpToDate and DynaMed is awesome. Especially for emergency medicine, being able to DDx complex situations quickly and provide immediate life-saving care is very important.
But — and I don't say this to provoke — I think this view is myopic. It somehow misses the humanity at the core of the doctor/patient interaction. What is the ultimate purpose of medical care, really? Is it not to treat the patient, and not simply cure the disease?
A lot of times the checklist-style of medicine forces patients into a loop of patchwork solutions which don't address the root cause. To an extent, this is even true in emergency medicine. If someone comes in with their third heart attack, and they're clearly obese and in bad health and spirits, the problem that needs to be fixed goes beyond the immediate danger of the heart attack. There's something much more systemic, much more basic, which lies at the core of this person's suffering.
And I think the same is true for many chronic diseases and ailments, which are hard and time-intensive to solve in a holistic way, but which are easy to treat with patchwork solutions.
Take also the recent advent in hospice care, which I find wonderful. Hospice kind of rethinks the concept of "curative" medicine and treats the patient as a human being. How many people spend their last days in a miserable state, burdening themselves and their families by forcing themselves to stay alive? The "treatments" justified in the name of life-saving care can be incredibly diabolical and torturous. Doctors know this, and they often spare themselves that gruesome fate: https://www.rd.com/article/how-doctors-choose-to-die/.
Point being — treating the patient is not as simple as it sounds. The proper treatment is not only to fix the immediate disease.
But again, I am not against checklists. Doctors who use checklists and can care for the patient at the deeper level of soul and psyche are golden.
Oh completely agree, there is no ‘one size-fits-all’ solution, my point is that a checklist based approach would cover most cases, and for the rest you can take a different approach.
Also just in case you are ever sick, you NEVER want to hear the words ‘oh that’s interesting’ or ‘you are an interesting case’... there are a lot of rare diseases of which there are maybe 10 cases reported in the medicine books, and sure your doc can diagnose it but there may be no good treatment options ( since there is so little data all the accepted treatments are just guesses ).
In any case, if I’M ever sick i hope i fit the checklist, at least i know the diagnosis and treatment is well known and defined.
Edited to add:
regarding hospice care, i wish this was more widely understood by non-medical people. I see so many people suffer unnecessarily because they don’t understand or their families refuse to understand. I cant speak about specific cases but I can say that some doctors have a gift of guiding their patients and some dont, and even the good one sometimes cant get through.
This is as you say a systemic problem and I dont have a good answer as to how to address it.
I work in a hospital setting and I would say 90+% of the time the issue is diagnosed following a checklist for a particular problem. In the medical field we are taught to think of a 'Differential Diagnosis', or DDx for short, and sort by probability based on the history, age, sex, etc of the patient. Of course in the hospital setting you would also think of 'which of these issues can possibly kill my patient in the next 24hrs' and look for those as well.
So you go down your DDx list and if you run out of diagnoses, go back to the history/patient and think about it some more or consult with your peers.
As far as the "House MD" situations, i haven't run into any of those so i can't comment on that part.