Teen Outsmarts Doctors In Science Class

Lousy work ethic infects all levels of the America's social structure. So, we get vice Presidents who can't spell, a President who can't speak properly in his own language and doctors who can't or wont do much more than take a guess at what ails their patients and dispense prescriptions based on their guesses.

Question: Was the doctor truly outsmarted; or did Jessica get lucky and have the only portion of tissue from the biopsy which contained granulomas?

Answer: We really can't tell from the details given in the article. The editor or author clearly wanted a catchy headline. But the claim of the headline isn't supported by the details within the article.

Why?
For those of us who read the *entire article, in detail,* we read the part where the author kindly points out two of the confounding factors with diagnosing Crohn's. 1) Granulomas aren't easy to find. 2) Sometimes granulomas aren't even present [in the biopsied, or inflamed, tissue].

Retort to: "But the doctor should have found the granulomas!"

Since a doctor can't know if there should be granulomas in the biopsied tissue, the doctor cannot be faulted for the granuloma not being there.

Retort to "Conflicting diagnosis 'prove' the doctor didn't know what he was doing!"

Since intestinal ailments all share a lot of signs and symptoms, the key differences will be small ones, like the presence of granulomas, or inflammation (or lack of it) through the the entire intestinal wall. The prior diagnoses actually serve to illustrate the complications in making diagnosis of any sort for intestinal ailments.

Retort to "the doctor wasn't diligent enough in his analysis of other indicators."

It's certainly POSSIBLE. But, those details aren't mentioned in the article so such a conclusion is not supported by the information that was given.

**Leaping to conclusions**

The retorts I've provided are for those out there who like to speculate about how things turned out the way they did. I'm not saying don't speculate! I'm saying, understand the limitations of the information you have, and reason things out carefully.

Now it's my turn to join in the fun of speculating!

First, lets start small and give the doctor some benefits of the doubt. 1) Assume a CBC and Sed rate were performed 2) Assume the Sed rate was on the high side of normal. 3 )Assume the doctor palpated her abdomen and found no "guarding" or mass within her abdomen. 4) Let's assume the lovely Jessica got to drink that tasty barium drink we all know and love, for a small bowel follow through and that nothing conclusive was found; or that instead of an X-Ray she was given a CT scan with contrast, and nothing overtly abnormal showed up.

The next step for any doctor would be to perform an endoscopy to visually inspect the region and grab tissue biopsies. The doctor *probably* did this as Jessica was in possession of tissue from her own intestine and the doctor had already run some analyses on it looking for abnormalities (likely looking for granulomas.) The information about her having the biopsy was given in the article. This means the doctor ordered a biopsy somehow... the safest way is through endoscopy.

Of course none of the benefits of the doubt I provided the doctor are directly supported by the article. They are, however, supported by my 26 years of experience as a Crohn's patient... Even the worst of doctors that I've seen have done all of the items I've assumed... And they always follow the same progression. Take history, palpate, bloodwork, X-Ray or CT depending on the situation, then endoscopy. They never start with endoscopy, it's riskier than the other diagnostics.