How Doctors Don’t Think About Brain Damage

Every day, I encounter another example, either in the calls we get from our websites, or in the news media, or some where else, as to how Doctors don’t ever consider the potential for brain damage in the differential diagnosis. While it isn’t a real world example, this one is kind of fun to make fun of.

On one of the most popular TV’s shows, Grey’s Anatomy, there is a classic scene between Meredith Grey and Christina where Meredith can’t sleep and Christina is trying to find the right diagnosis. They are apparently studying from what has to be the DSM-IV (Diagnostic Statistical Manual – IV – the psychiatrict bible), discussing her depression and difficulty building an adult relationship with Dereck Shepard. They discuss her issues and Christina looks at the bullet points in the DSM-IV and comes up with “abandonment issues.” OK, makes sense, the plot of the TV show sort of revolves around her psychological issues.

But wait: Didn’t Meredith suffer severe brain damage? Wasn’t she the girl who drowned, was actually dead? Wasn’t that her who they fought and fought and fought to bring her back from the dead? Hmmm.. It is only a TV show, but wouldn’t all that time where blood was not circulating thru her brain have caused some pretty severe brain damage. Miracles are miracles, but still, if she had emotional issues, or problems sleeping a few months later, wouldn’t these brilliant doctors at least consider the possibility of “BRAIN DAMAGE.”

Christina, you could look it up in a lot of other books: emotional detachment, sleep problems, these are also symptoms of brain damage. Click here for a synopsis of this TV episode.

There is an excellent book out recently entitled “How Doctor’s Think” by Dr. Jerome Groopman. It details why medical misdiagnosis is such a common problem and is important reading for everyone. An excellent podcast interviewing Dr. Groopman is available here: http://www.onpointradio.org/shows/2007/11/20071113_a_main.asp

I think the corollary to that book should be: “How Doctors Don’t Think About Brain Damage.” Why is it, that the potential for brain damage is rarely considered in the differential diagnosis? Even Dr. House makes this mistake. (A comment made facetiously about another medical show on TV).

Another example from today’s news: In the inquest into the death of Princess Diana, Trevor Rees, who was severely injured in the crash on Aug. 31, 1997, also denied allegations by Fayed’s father that he had participated in a cover-up of the truth.

“I have no memory of — after leaving the back of the hotel. That’s my last true memory,” Rees said. Of course it is. Rees suffered a severe brain injury in this accident. But even dumber than this continued effort to get the “truth” out of the only survivor of the crash, is the statement from Psychiatrist Maurice Lispedge in court that the chances of Rees recovering his memory were “slight”. They are not slight. They are non-existent. His brain did not save any of those memories. Any so-called memory he could possibly have, would not be a real memory. This is a classic case of retrograde amnesia. How can Western society be so ignorant as to expect him to remember anything material? http://ap.google.com/article/ALeqM5gt4lktu_9eR8cCLZsfdDdwu3h3cwD8UBJ0100

How do we get doctors to think about Brain Damage? Hit them over the head with it, again and again. Maybe in the spirit of the classic Hollywood head injury myth, the repeated blow to the head will trigger the memory of that little tiny part of medical school where they were supposed to learn about brain damage, brain injury, neurobehavioral deficits and the interplay between organic brain damage and emotions.