>He spent two days poring over her records, and got her the diagnosis no one else did - got her on the right tx, and gave her her life back.

Well, quite frankly, this is part of the problem and it's a social adjustment we need to make as well. We see this with virtually any position where you need to diagnose; 99% of the time it's a simple issue from column A, but occasionally you get a symptom that looks like the issue is from column A but it's actually in column B. In technology, we fly through column A solutions because they're cheap, fast to test, and often done without cost, and column B solutions are more drastic, more expensive, and sometimes more dangerous.

The difficulty in translating this to medicine is that a lot of times column B solutions are dangerous to the point of no return. Combine this with the fact that there really aren't rollbacks when it comes to health, you have actual life or death decisions to be made.

Taking the time to review the whole history can really help with this and to get a full timeline of events, but even then it's hard to get past the column A/B thinking. I've been dealing with a very annoying sinus issue for 3 years across about 8 doctors from across the planet (due to moving because of work). Every time I've started anew with a doctor, they go down the exact same treatment list as the previous, and when they're told that I've done that already, they just want a repeat. I understand this thought process (what if I'm lying, what if they bungled the test, what if something changed, etc), but I've done this 8 times now. I've been told each time it's an allergy, but every time we see an allergist, they can't get me to react to any allergen they have available to test for and are left scratching their heads as to why antihistamines don't have any effect. They also can't find a common cause that fits with allergies, but in their minds, it just looks so much like allergies they're not sure what else to test. I secretly suspect that if I could just get a doctor to spend more than 20 minutes in a consult to review the case and what I've done so far we could try something else, but regardless of where I've been, I just can't get a doctor to look too much longer. They either don't believe the symptoms as I report them, don't believe the steps I've already tried to resolve it, or they just don't have the time to care past the initial look at the symptoms.

I appreciate the difficulty in having to do this: when column A fails, it looks great if you pick the right item from column B, but it also gets really expensive while you shop around to find the right item from column B. They make it look so easy on House, but no place is willing to really do that sort of patient history and testing, and if the condition is not life threatening, then it's just a "deal with it" situation, we're gonna keep throwing the easy stuff at the symptoms until the person stops complaining.

I don't know what the problem is or how to embolden doctors to take a little more time, but some change would be nice. Though, hearing stories from my mother who has been a nurse for 20+ years, sometimes emboldened doctors look for problems that aren't there so they can look like heroes.

It's a crazy thing with health and unfortunately the value of such emboldened decisions tends to be a very ad-hoc assessment. If it worked well, it was a gutsy but necessary maneuver. If it did nothing, it was reckless. If it caused harm, it was malpractice.