Recently, I was talking with my mechanic and he was trying to convince me that doctors and mechanics have very similar jobs, as both mechanics and doctors use similar patterns of diagnosing problems and prescribing solutions. Mechanics work with your vehicle, doctors with your body.
The history and Physical exam
When your car has trouble, you go to the mechanic and try to describe what brought you in: “a clang,” a bang, a shimmy, or a warning light coming on. Sometimes the problem, and its solution, it is straightforward and easy. “Classic” descriptions of symptoms are their own diagnosis, and there is little thought needed for 95% of the situations. Uneven tire wear is an alignment problem. A dead battery is either a dead battery or an alternator problem, and there are specific steps to diagnose the problem. It’s similar in medicine.
In medical school, we hear the phrase, “if you hear hoof beats, think ponies not zebras.” An example of a pony in the foot world: A patient complains of new onset heel pain (pain upon first few steps in the morning, or after sitting for a couple of hours) 73% of the time, the pain is from plantar fasciitis. If a patient complains, that “it felt like someone kicked me in the back of the leg, but no one was there,” and the patient has pain in the Achilles tendon, it’s most likely an Achilles tendon rupture. In any case, an astute physician will perform a detailed physical exam to confirm as well as rule out other possibilities, just like the mechanic runs tests to confirm diagnosis. Before testing for uncommon problems, first, we rule out the most common causes.
Assessment and plan
Once the diagnosis is reached, the mechanic brings you the news by either showing you the problem under the vehicle or the paper with the results…The same with the doctor… You’ll see the results of tests, and your doctor will explain the problem and possible treatment options.
Hopefully, both your doctor and your mechanic are being thorough and ruling out zebras and corralling all of the ponies.