Diagnostician Quotes

In a dying civilization, political prestige is the reward not of the shrewdest diagnostician, but of the man with the best bedside manner.

In a dying civilisation, political prestige is the reward not of the shrewdest diagnostician but of the man with the best beside manner. It is the decoration conferred on mediocrity by ignorance. Yet there remains one sort of political prestige that may still be worn with a certain pathetic dignity; it is that given to the liberal-minded leader of a party of conflicting doctrinaire extremists. His dignity is that of all doomed men: for, whether the two extremes proceed to mutual destruction or whether one of them prevails, doomed he is, either to suffer the hatred of the people or to die a martyr.

Asperger survived the war, but his concept of autism as a broad and inclusive spectrum (a “continuum,” his diagnostician Georg Frankl called it) that was “not at all rare” was buried with the ashes of his clinic and the unspeakable memories of that dark time, along with his case records. A very different conception of autism took its place.

Curiosity. It was Oliver Sacks who first made me reflect on curiosity as a form of compassion. An ingenious and creative neurologist now well-known for his “clinical tales,” he begins his work as diagnostician and healer with the implicit question ‘What is it like to be you?

To be a good diagnostician, a physician needs to acquire a large set of labels for diseases, each of which binds an idea of the illness and its symptoms, possible antecedents and causes, possible developments and consequences, and possible interventions to cure or mitigate the illness.

Consider the top man–machine medical diagnosticians, circa 2035. They will make life-and-death decisions for patients, hospitals, and other doctors. But what in a malpractice case should count as persuasive evidence of a medical mistake? The judgment of either “man alone” or “machine alone” won’t do the trick, because neither is up to judging the team. Sometimes it will be possible to ascertain that a top human team member was in fact a fraud, but more typically the joint human–cyber diagnostic decisions themselves will be our highest standards for what is best. Having one team dispute the choice of another may indicate a mistake, but it will hardly show malfeasance. When

To be a good diagnostician, a physician needs to acquire a large set of labels for diseases, each of which binds an idea of the illness and its symptoms, possible antecedents and causes, possible developments and consequences, and possible interventions to cure or mitigate the illness. Learning medicine consists in part of learning the language of medicine.

To be a good diagnostician, a physician needs to acquire a large set of labels for diseases, each of which binds an idea of the illness and its symptoms, possible antecedents and causes, possible developments and consequences, and possible interventions to cure or mitigate the illness. Learning medicine consists in part of learning the language of medicine. A deeper understanding of judgments and choices also requires a richer vocabulary than is available in everyday language.

I know that to say 'we'll see each other tonight,' up front, and with an exclamation point rather than a question mark, gives me more of a chance than 'are you free tonight?' In surprise, there's always a moment of hesitation; he knows that I know that it contains the possibility of his resorting to a lie, and that if he says no to me it isn't necessarily that he isn't free, but that he has decided as much, that he detected a hint of pathos in my voice, and doesn't want to come to its rescue; he only says yes when we share a common prescription; he is always the diagnostician of our relationship.

In the most devilishly wicked learning environments, experience will reinforce the exact wrong lessons. Hogarth noted a famous New York City physician renowned for his skill as a diagnostician. The man’s particular specialty was typhoid fever, and he examined patients for it by feeling around their tongues with his hands. Again and again, his testing yielded a positive diagnosis before the patient displayed a single symptom. And over and over, his diagnosis turned out to be correct. As another physician later pointed out, “He was a more productive carrier, using only his hands, than Typhoid Mary.” Repetitive success, it turned out, taught him the worst possible lesson.

In 2009, Kahneman and Klein took the unusual step of coauthoring a paper in which they laid out their views and sought common ground. And they found it. Whether or not experience inevitably led to expertise, they agreed, depended entirely on the domain in question. Narrow experience made for better chess and poker players and firefighters, but not for better predictors of financial or political trends, or of how employees or patients would perform. The domains Klein studied, in which instinctive pattern recognition worked powerfully, are what psychologist Robin Hogarth termed “kind” learning environments. Patterns repeat over and over, and feedback is extremely accurate and usually very rapid. In golf or chess, a ball or piece is moved according to rules and within defined boundaries, a consequence is quickly apparent, and similar challenges occur repeatedly. Drive a golf ball, and it either goes too far or not far enough; it slices, hooks, or flies straight. The player observes what happened, attempts to correct the error, tries again, and repeats for years. That is the very definition of deliberate practice, the type identified with both the ten-thousand-hours rule and the rush to early specialization in technical training. The learning environment is kind because a learner improves simply by engaging in the activity and trying to do better. Kahneman was focused on the flip side of kind learning environments; Hogarth called them “wicked.” In wicked domains, the rules of the game are often unclear or incomplete, there may or may not be repetitive patterns and they may not be obvious, and feedback is often delayed, inaccurate, or both. In the most devilishly wicked learning environments, experience will reinforce the exact wrong lessons. Hogarth noted a famous New York City physician renowned for his skill as a diagnostician. The man’s particular specialty was typhoid fever, and he examined patients for it by feeling around their tongues with his hands. Again and again, his testing yielded a positive diagnosis before the patient displayed a single symptom. And over and over, his diagnosis turned out to be correct. As another physician later pointed out, “He was a more productive carrier, using only his hands, than Typhoid Mary.” Repetitive success, it turned out, taught him the worst possible lesson. Few learning environments are that wicked, but it doesn’t take much to throw experienced pros off course. Expert firefighters, when faced with a new situation, like a fire in a skyscraper, can find themselves suddenly deprived of the intuition formed in years of house fires, and prone to poor decisions. With a change of the status quo, chess masters too can find that the skill they took years to build is suddenly obsolete.

It is perfectly true that many cases of subnormal energy can be helped by the proper glandular dosage, but how many of those who have spoken to you of being probably hypo-thyroid* ever went through the simple process of having a basal metabolism test to see if that were really the trouble? Of course they can claim that the situation is so grave that they cannot even get up energy to start being cured; there’s no answer to that one. But if you are really seriously handicapped by lethargy, you can take your first successward step by consulting a good diagnostician, if necessary. If necessary, mind; for there is a fact which makes a good deal of the talk about glandular insufficiency look like the alibi it too often is, and which will be confirmed for you by specialists in glandular therapy if you ask them: that if those who complain of lethargy increase their habitual activity little by little the glands respond by increased secretion. In short, very often this condition can be cured by starting at the other end! You may rest assured that you will have no consequent breakdown in following this advice unless you deliberately (and with intent to cripple yourself) leap from a practically comatose state to one of manic activity.

Diagnosticians of society should play their mission coldly and clinically. They should not be compelled to minister to morale. That should be left to coaches, therapists, clerics, or the like. If a commentator perceives a situation to be hopeless, he should say so.

To diagnose means grasping things as they really are, so as to do the right thing. Hence, in medicine, diagnosis at its best entails etiology, for the penetrating view arrives at causes and deals with patterns of cause-and-effect relations in the course of illness.

He was a penetrating diagnostician who went well beyond surface impressions. He distinguished between good and poor diagnostic indicators and felt that some “signs” are suspect, if not worthless. For instance, he saw no diagnostic value in the mere intensity of affections; he would not take body effects and verbosity as yardsticks of conversion. He distrusted some clients’ lavish use of Biblical proof texts, and saw no diagnostic value in the mere frequency of worship attendance and profuse engagement in God-talk.

It's not just our high-mindedness or altruism that keeps us off "the scent," nor is it that our public is not interested in "higher" things (they are). Some basic unwillingness to see things as they are and then attempt to take corrective action is missing in our present make-up. We are neither good diagnosticians nor good leaders. Rather, caterers and men of fashion. More interested in curtain walls than how to accommodate the car.

The worst diagnosticians of every epoch are its contemporaries.

People will continue to be critically important in the improved health care delivery systems of the future, but not always in the same roles as today. Emotionally and socially astute care coordinators, rather than brilliant diagnosticians and other HiPPOs, might move to center stage. Earlier, we told the old joke about the two employees—person and dog—in the factory of the future. We suggest a slight tweak for health care: the medical office of the future might employ an artificial intelligence, a person, and a dog. The AI’s job will be to diagnose the patient, the person’s job will be to understand and communicate the diagnosis, and to coach the patient through treatment, and the dog’s job will be to bite the person if the person tries to second-guess the artificial intelligence.

Diagnosticians act in many ways like politicians who may overtly take their differences very seriously but are always willing to shake hands in a smoke-filled room

IT IS BEST TO THINK OF DEDEKIND AS A GREAT DIAGNOSTICIAN, A DOCTOR of discovery.

if you don’t synthesize knowledge, scientific journals become spare-arts catalogues for machines that are never built,” he explained. “I am as good a diagnostician of ecosystems as any doctor is of human beings, and I’m not on any damn ego trip when I say that. Sometimes I wish I did’t have the knowledge hat I do, because I can get pretty damn glum.

Economists at Oxford University estimate that about half of American jobs, including millions and millions of white-collar ones, are susceptible to imminent elimination due to technological advances. Analysts are warning that Armageddon is coming for truck drivers, warehouse box packers, pharmacists, accountants, legal assistants, cashiers, translators, medical diagnosticians, stockbrokers, home appraisers—I could go on.

Knowingly accepting oneself is the quintessential mission of every person. We each must fix ourselves, make ourselves right with the world we were born into, and construct a satisfactory existence out of our very own scarf. I am my personal healer, diagnostician, etiologist, psychiatrist, and neurologist.

The McLean people recommend fluoxetine because they have diagnosed me with atypical depression. This diagnosis was not easy for them, or for Dr. Sterling, to come by, as the occasional appearance of manic-like episodes (for instance, during my energetic first month in Dallas) might indicate that I suffer from either manic-depressive illness or cyclothymia, a milder type of mood-swing disease. But in the end, the diagnosticians conclude that I’ve been too persistently down and not florid enough in my manic periods to be bipolar. Atypical depression is long-term and chronic, but the sufferer’s mood can occasionally be elevated in response to outside stimuli. This diagnosis seems a better way to explain the periodic occasions when I seemed happy or productive, but would always return to my normally depressed state in perfect boomerang fashion.

Desperate to join the medical mainstream, psychiatry recognized that its diagnostic system was grossly inadequate. For instance, in the 1968 second edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-II), depressive neurosis was defined as “An excessive reaction of depression due to an internal conflict or to an identifiable event such as the loss of a love object or cherished possession.”4 Is moderate depression a week after the loss of a favorite cat “excessive”? One diagnostician would say, “No, not at all, people love their cats”; another, “After a week, it is obviously excessive!” Such disagreements made psychiatry’s scientific aspirations laughable. The solution was a radical revision, DSM-III, published in 1980.5 Written by a task force of the American Psychiatric Association under the leadership of psychiatry researcher Robert Spitzer, it purged psychoanalytic theory from DSM-II and replaced its 134 pages of clinical impressions describing 182 disorders with 494 pages of symptom checklists that defined 265 disorders. “Depressive neurosis” was eliminated. The definition of a new diagnosis, “major depressive disorder,” said nothing about internal conflict; it only required the presence of at least five of nine possible symptoms for at least two weeks. Every diagnosis was now defined by a checklist of necessary and sufficient symptoms. DSM-III transformed psychiatry.6 It made possible standardized interviews that epidemiologists could use to measure the prevalence of specific disorders.