Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Why diverticulitis can be an elusive diagnosis

Michael Kirsch, MD
Conditions
November 7, 2019
Share
Tweet
Share

I have been treating diverticulitis for 30 years the same way. When I suspect that a patient has this diagnosis, I prescribe antibiotics. This has been the standard treatment for this disorder for decades. I have found that diverticulitis is a slippery entity that has two trap doors waiting for physicians to fall through.

It is an easy task to miss the diagnosis. Every physician has done this.

The diagnosis can be erroneously assigned to a patient. Every physician has done this.

Recognize that the phrase “every physician has done this” includes me.

The diagnosis can be elusive as there is no diagnostic test that secures the diagnosis. The technology tsunami has covered the medical landscape, as it has run over so many other spheres in our society. Doctors and patients increasingly rely upon the numbers. Want proof? Do you think there are many physicians today who can actually plug a stethoscope into their ears and hear, let alone understand all of those clickety-clackety heart sounds? And, if they do, they order an echocardiogram anyway.

The medical community and those we serve are hyperfocused on objective data – stuff that can be measured. Here are three examples of seemingly reasonable questions that I believe often miss the mark.

  • What did the CT scan show?
  • Did the tumor marker decrease?
  • Is my carotid arteries screening test normal?

A more relevant question, such as “How is the patient doing?”, is ignored or relegated to lower priority status. Who cares if the tumor marker goes down if the patient doesn’t feel any better?

So, when diverticulitis is a consideration, a physician actually has to act like a doctor. Sure, a CT scan can be consistent with diverticulitis, but many other conditions can precisely mimic this CT scan appearance. So, the physician has to make a clinical diagnosis of diverticulitis. This means that the doctor must analyze all of the data – your symptoms, the labs, radiology results – and then make a judgment. A common error is when the diagnosis is prematurely made based primarily on the CT scan, without weighing other factors. A clinical diagnosis of diverticulitis can also be made without a CT scan or laboratory data. Yes, the doctor can actually perform old fashion doctoring, which has become rather quaint these days.

In my practice, many patients who come to me complaining that they are experiencing a flare of their diverticulitis are mistaken. There is some other explanation for their stomach pain. Or, the patient may state that the pain is identical to a prior episode of diverticulitis, but often the original diagnosis of diverticulitis was incorrect or uncertain. Yes, I admit again there is always the chance the patient is right, and I am wrong, but hopefully, my decades of training and experience are worth something.

My points above are certainly not restricted to diverticulitis. They cross into every medical specialty. Technology and objective data too often wag the dog. Who do you want evaluating your medical symptoms, a physician, or Alexa?

Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.

Image credit: Shutterstock.com

Prev

The healing patient-physician analog relationship is in critical condition

November 7, 2019 Kevin 9
…
Next

How compensation can affect physician burnout

November 7, 2019 Kevin 0
…

ADVERTISEMENT

Tagged as: Gastroenterology

Post navigation

< Previous Post
The healing patient-physician analog relationship is in critical condition
Next Post >
How compensation can affect physician burnout

ADVERTISEMENT

More by Michael Kirsch, MD

  • Are Ozempic patients on a slow-moving runaway train?

    Michael Kirsch, MD
  • AI-driven diagnostics and beyond

    Michael Kirsch, MD
  • The surprising truth behind virtual visits

    Michael Kirsch, MD

Related Posts

  • 5 urban legends about risk-adjusted diagnosis coding

    Betsy Nicoletti, MS
  • Diagnosis: malformation of a health care system

    Jeffrey Fraser, MD
  • How to do risk-adjusted diagnosis coding the right way

    Betsy Nicoletti, MS
  • A fatal diagnosis doesn’t mean life is finished

    Jennie Dear, PhD
  • Getting a terminal diagnosis for my baby

    Sophia Zilber
  • Retrospective refusal of payment based upon final diagnosis compromises patients’ welfare

    David Hoke, MD, MBE, Kenneth V. Iserson, MD, MBA, and Jesse Basford, MD

More in Conditions

  • Why telling kids to eat less and move more fails to address obesity

    Callia Georgoulis
  • Clinical ghosts and why they haunt our exam rooms

    Kara Wada, MD
  • High blood pressure’s hidden impact on kidney health in older adults

    Edmond Kubi Appiah, MPH
  • How declining MMR vaccination rates put future generations at risk

    Ambika Sharma, Onyi Oligbo, and Katrina Green, MD
  • How one unforgettable ER patient taught a nurse about resilience

    Kristen Cline, BSN, RN
  • Why regular exercise is the best prescription for lifelong health

    George F. Smith, MD
  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Why telling kids to eat less and move more fails to address obesity

      Callia Georgoulis | Conditions
    • Why enterprise risk management is key to value-based health care success

      Olumuyiwa Bamgbade, MD | Physician
    • Rethinking physician resilience for sustainable well-being

      Sarah Webber, MD | Physician
    • How shared language saved a patient from isolation

      Syed Ahmad Moosa, MD | Physician
    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Why telling kids to eat less and move more fails to address obesity

      Callia Georgoulis | Conditions
    • Why enterprise risk management is key to value-based health care success

      Olumuyiwa Bamgbade, MD | Physician
    • Rethinking physician resilience for sustainable well-being

      Sarah Webber, MD | Physician
    • How shared language saved a patient from isolation

      Syed Ahmad Moosa, MD | Physician
    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...