It's my experience w/every primary care doc I've ever had (& all specialists, save one) that doctors really, really need better training in diagnostic thinking. Basic errors in logic are frequent, inability to recognize conditions that co-occur are not nec. linked, etc. I read (1

medical literature and lit about cognitive biases and other errors in reasoning, so I am able to self-diagnose in a way few patients probably are. But most patients are at the mercy of a doctor who probably lacks fundamental reasoning skills necessary for figuring out what is (2

wrong with them. This week, I figured out that my mouth issue was probably a bacterial infection. I had stupidly cut my gum not once but two times and then cut it again. Dental implement then sharp food. Slob Genius Amy. Anyway, I read papers on mouth cancer & all the other (3

horrifying things that go on with mouths and figured out that I should take amoxicillin for a few days and if it didn't get better, go in to urgent care. (Dentist disappeared a few months ago and may be dead, a friend thinks!) Well, my doctor thought it was "viral." With no (4

Reason that would be the case. I don't have herpes or HPV and the symptoms matched bacterial infection. She wouldn't prescribe amoxicillin I asked for. Said I needed an appointment w/other doc, which I could only get late in day. I'd msged her 2 days before & she ignored my (5

msg, probably because she had no idea what to do. (My guess, maybe unfair.) I said, amoxicillin isn't dangerous, haven't taken antibios since maybe my 20s (once) and I'm 56, and if doc at 4pm that day (I was begging since 2am for amox) said amox was wrong, no harm...I'd just (6

stop taking it. No biggie. It's not some dangerous drug or a cocaine-like potion. I was in searing pain two days after I'd first emailed her, worried about losing teeth and how periodontal issues can lead to cardiac ones. This is a general idea I have from reading, not (7

A well-investigated one. She stuck to it, and I was to wait till 4pm with this silly 10 minute phone (no video!) appt with other doctor. I lost a writing day from being in searing pain and being terrified. I finally got the amoxicillin & - of course - it cleared the infection (8

up a great deal almost IMMEDIATELY. It seemed to work a little with the first pill, and the second helped much more -- so much so that I woke up at 3am to take a third (needed to put time between pills). If this doctor had simply had basic diagnostic and reasoning ability, she (9

Could have seen that the risks from giving me amoxicillin (before I had to wait three days or wait all day for a doctor) were minimal, to say the least, and she would have understood that it was highly unlikely I had any viral infection. Trauma from sharp things, sure, could (10

Have been coincidental (with some infection) but Occam's Razor, please. Especially since amoxicillin is not likely to cause me to fall on the floor and have a seizure, etc. It's simply a little hard on my stomach and makes my head feel a little not my own (less so as I (11

Continue to take it. And yes, eating gross probiotic yogurt so I won't get c-dif, etc., from loss off good bacteria in my stomach. Hero boyfriend got me the last one at Ralph's along with my prescription for amoxicillin.

Please, med school deans, diagnostic thinking needs (12

Serious attention it ain't getting. Make them read Gigerenzer, Andrew Gelman, Sander Greenland, "Mistakes Were Made..." by Tavris & Aronson, and all the other texts that help one understand cognitive biases, errors in reasoning, and stats stuff like absolute vs. relative, so (13

they can ask right questions when drug rep tells them the supposedly amazeballs results from potion they're hawking. (Oh, & they should read Angela Fugh-Berman on how good bit of research database has been ghostwritten by drug cos, & related work that advances skepticism) (14 END