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Wednesday, April 24, 2024 at 4:27 PM

Diagnostic Momentum

Around Thanksgiving 2021 fifteen- year-old Alice Tapper began to suffer from abdominal pain. The pain became unbearable enough that her pediatrician, fearing appendicitis, sent her to the hospital.

Around Thanksgiving 2021 fifteen- year-old Alice Tapper began to suffer from abdominal pain. The pain became unbearable enough that her pediatrician, fearing appendicitis, sent her to the hospital.

She was admitted to the hospital with low blood pressure, an elevated heart rate, intense abdominal pain, and a high white blood cell count. She said the doctors and nurses “didn’t know what was wrong and stood around,” adding that their confusion made it seem like t hey w ere “ waiting f or m e t o tell them what to do.”

Transferred to another hospital the doctors there dismissed the preliminary diagnosis of the pediatrician as being appendicitis because Ms. Tapper’s abdominal pain was not limited to the lower right side of her abdomen. They decided it was a viral infection and would just have to run its course.

Her father, Jake Tapper, a CNN news anchor, asked for antibiotics and was told that could only worsen her condition. A request for an x-ray was dismissed as unnecessary.

When her condition worsened with fever, lowering blood pressure, a greenish tinting of her skin, and an agonizing increase in her pain, her father made a direct call to the hospital administrator requesting that the hospital X-ray her daughter’s abdomen.

The ordered X-ray showed that Ms. Tapper did indeed have appendicitis that had a life-threatening rupture of an infected appendix. Fortunately, the now-needed emergency surgery was able to save her life.

There is a “medical” term for what happened to Alice Tapper: Diagnostic momentum, where subsequent doctors follow the lead of the initial doctor, in this case the first doctor to see Ms. Tapper at the hospital.

In an op-ed piece for CNN reporting on her ordeal Alice Tapper wrote “despite being the most common surgical emergency in children, appendicitis can be missed in 15 percent of children at initial presentation.”

I’m sure that medical professionals are studying the problem of diagnostic momentum and developing protocols for doctors and nurses to not merely pick up the thread of the immediately preceding diagnostician, but to look carefully at the all the data, starting with the initial complaint.

There is a first cousin to “diagnostic momentum” that challenges all of us on a d aily basis. It is the momentum that propels us to accept an idea without fully investigating its origins and the consequences of buying into its unproven veracity.

Much of the time it is of little consequence, with the gullible being scammed out of a few dollars looking for something to be wasted on.

It’s awfully easy to persuade someone to accept an idea they’re anxious to believe. It’s what sells hair growth snake-oil to the balding, wrinkle remover touted by a “beauty” model (with lots of makeup) to the fearfully aging, and memory “restorer” to the easily frightened of going senile.

“In clinical trials has been shown to …,” “Clinically proven to …,” “Pharmacist recommended …,” and anything lacking “approved by the Food and Drug Administration” are not honest assessments of a product’s effectiveness.

“This very fantastic product may soon be discontinued! Order now!” is also a momentum builder. Does something this lame really move people?

Celebrity endorsements are another way consumer momentum to buy is created. I don’t know how a football or basketball star adds flavor, or any value, to a submarine sandwich. I ’m s ure t hey a dd e xpense t o t he s andwich. T heir e ndorsements are not done for free.

Consumer momentum is a relatively benign way to separate people from their money. After all, with the obsession about our appearance and our fondness for food, there’s little inertia keeping that ball from rolling on its own.

Some momentum building leads to much more sinister results. It’s what drives every mob to do things a lone individual might never be driven to do alone. The propagandist counts on such momentum to move people to support the ideas and goals of the propagandist. Truth is abandoned for rumor and pandering to the prejudices and fears of the masses.

Unlike Truth there is always some falsehood that satisfies. Truth is limited to a straight and narrow road, while fiction has an unlimited universe of variable explanations and pseudo-rules.

Will Rogers, the good-natured cowboy/satirist/columnist of the first third of the last century, observed that “Rumor travel faster, but it doesn’t stay put as long as Truth.”

Rumor has many synonyms: conspiracy theories, gossip, hearsay, falsehood, the humorous tarradiddle and blarney, the college educated mendacity and prevarication, but they’re all just the common lie. It can’t stay put as long as Truth. Truth can take examination. It is steadfast and has no need to distract or mislead or the ability to morph into something more palatable and still be the Truth.

The lie can only survive where it has momentum supplied by the dishonest and their unwitting ally, the easily duped or cheated.

And the individual who yields his or her own decision-making to others who don’t know or respect that individual’s own sensibilities and wishes.


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