Tech Support And The Challenges Of Clinical Reasoning

If you listen to the patient, they will tell you what is wrong.

This is a phrase I like to use when I am teaching clinical reasoning and decision-making. Listen to the patient. The patient has one witness, the clinician has none. Our task as clinicians is to ask the right questions and to make sense of the truths offered by the patient and their particular clinical presentation.

Strangely enough, dealing with tech support is no different.

Oh, if only they had listened to me on the first call, let alone the 7th.

It all started late Sunday night when I was suddenly unable to access my website. Strangely enough, it was the only website I was unable to access from my home Internet connection. It didn't matter what device I used or what operating system it used. Nada. Zilch. I knew something was amiss when I could access it via smartphone.

I will be the first to admit that I am not an expert on computers or networking or internet protocols or the like. But I do know how to step through an issue logically and at least know where to look for the problems and solutions.

Acknowledging your limitations is a good thing. That was the case with technician #1. It went downhill from there.

Over the course of 24 hours, through a total of 8 hours of tech support, I was given a long laundry list of each technician's favorite "diagnosis". All of them had no relevance to the issue whatsoever. There was a litany of excuses that didn't even fit the logic tree. It became apparent that they simply weren't listening. Repeatedly.

It came to a head when I was told that my web hosting was the problem. Of course, my website was accessible by any of the 2.8 billion people on the planet that have Internet access, just not from the home of one Allan Besselink. Trust me, I asked all of them.

The last technician, who we shall simply name "Lucky #7" simply decided he'd had enough - and left the conversation. Oh, and without performing any task that actually solved the problem at the time, I might add.

The fiasco did accomplish one good thing. It reminded me of the challenges inherent to critical thinking, be that during tech support or during a patient interview. Most important of all: you have to listen to the client - really listen, reframe effectively, and comprehend the issues at hand. Relevance and context are key. Timing is important. Causation and correlation are critical. You have to consider all the options. You have to realize that all the parts must fit - because, obviously, they do otherwise this problem wouldn't exist! If they don't fit, you need to re-consider your working hypothesis. As a clinician, you must then strive to not contaminate your decisions with confirmation bias or your favorite diagnosis.

While in the midst of it all, this ordeal provoked frustration - much like many patients may experience in health care. But it did remind me, as a clinician, of the importance of good communication, sound logic, and methodical hypothesis testing. It brought relevance and context to the forefront.

A teachable moment, indeed. With any luck, "Lucky #7" learned something as well.

Photo credits: quapan

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