Millions watched the latest episode of Downton Abbey where the lovely Lady Sybil’s protracted labor raises viewers anxiety as the drama unfolds. Relief engulfs the family as a healthy daughter is born and the weary mother told to rest. But even if you are not a clinician you are left with the feeling that things are still not right. Soon we see why…she experiences minutes of agony in seizures and dies as her family and the two physicians watch, helpless.
Now what can we as 21st century folks take from this drama that may help us, or a loved one needing care? I believe stories are a rich learning tool and this one offers us three important messages.
- Don’t be afraid to seek a second (or even third) opinion
- Diagnosis is not an absolute. Although the process does have systematic steps, usually, it is not a finite science. Big data technology is growing and will offer better methods for diagnosis in the future, but we are not there yet.
- Your hunch, frustration, or sense of being overwhelmed about a diagnosis is an important clue to follow…it may save your life.
- Don’t be swayed by titled arrogance
- Sir Phillip’s are alive and thriving today in all specialties. Do not assume this would not happen today…it does. A physician so convinced that their diagnosis is the only one that is correct has a blind spot that may harm or even kill you or a loved one, as it did Lady Sybil.
- Ask to see the current best evidence
- This is my favorite topic because we still have so much work to do to make the use of current best evidence a reality everywhere. The family doctor was the one informed about the symptoms of pre-eclampsia and aware of the evidence that birth is the only “cure” for this incredibly interesting and unpredictable disease. But he too was unaware of the evidence for treatment.
- In 1906 Dr Horn identified the use of Magnesium Sulfate to manage pre-eclampsia/eclampsia. Lady Sybil died in 1920 that is 14 years after evidence showed this as an effective treatment. In fact it is a mainstay of treatment today.
If I say today we still have a lag time of 17 years before we fully integrate best evidence into clinical care, are your surprised or concerned?
Learn more in the next three posts where each of the key messages is discussed in more detail.