So two weeks ago my washing machine started leaking.
In the style of a GP problem solver I :
– checked if the adjacent beer fridge was leaking;
– checked the inlet and outlet hoses;
– checked the washing machine valves;
– checked the dog hadn’t wee’d on the floor again;
– read the troubleshooting manual;

And then I called in the professionals after reporting to the ‘washing machine receptionist‘ that the ‘washing machine was leaking onto the floor’ (Presenting complaint).

The professional (Washing Machine Doctor) came.   He looked at the puddle on the floor.  He checked his job sheet for the presenting complaint and checked it was correct (History). He bounced the ‘barrel’ up and down (Examination) and said “The suspension is your problem” (Diagnosis) and quickly replaced it for a hefty sum (Treatment). And whom am I to question this management based on my vast knowledge of washing machines?

Two days later, water continues to run through the machine and onto the floor.   Urgent call with impending end of working and school week washing looming, (within business hours to avoid the ridiculous call out fee of course).   The wise professional says “Yes, the running water has now destroyed your electronics” (Alternative diagnosis). A week wait and  new electrics that cost a month’s worth of medical indemnity insurance.

One week on, machine leaking, water running through, washing machine shorts out the power. Call to the “washing machine receptionist” – on explanation of our previous experience and remedies her answer was, “perhaps it was a different problem in the first place?” (What about the diagnosis not to be missed?, not to mention some investigations)

Hence, pattern recognition happens everywhere.   Diagnostics and time taken in the first instance are so important.    Two more days waiting with stinky, wet clothes, and that’s just for a consultation. This is a first world problem I know but I did feel like suggesting what it would be like if we performed our job as medical practitioners similarly to this technician?   Yes, there are mechanics in the human body but the complexity of human nature, conditions, and diagnostics, means that pattern recognition is not enough –  if we take presentations at face value without exploration we are bound to encounter repetitive errors and serious consequences, including slippery floors and wet and dirty mess. Sometimes the clothes won’t be washed, there will be nothing to wear, and we will be exposed. That’s why we need to clinically reason and demonstrate those skills in exams such as the KFP, but more importantly in our daily practice.

The answer is in the question, not what we assume to be the answer.

Please feel free to comment.

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