Last year, a cardiologist at my institution presented the story of a patient he had cared for and correctly diagnosed with a not uncommon condition after several other physicians had failed to do so. The patient was a 72-year-old man with near syncope after exercise for several months, with no other symptoms or clues to the diagnosis. The cardiologist asked him to discuss each episode in detail, and the man noted that each morning, he walked briskly on his treadmill for 30 minutes, stopped and checked his pulse, and they would experience several minutes of lightheadedness that would dissipate by the time he walked from the basement to the first floor.
Electrocardiograms and Holter monitoring did not provide an answer, and plans were made for an exercise stress test. After hearing the story, the cardiologist astutely asked: “Can you demonstrate how you check your pulse?” The patient raised his hand to his neck and was immediately asked to lay down on the exam table with the cardiologist applying gentle pressure to the carotid sinus, a continuous electrocardiogram revealed a five-second ventricular pause and the patient noted the onset of his typical post-exercise lightheadedness.
As the discussion on carotid sinus hypersensitivity — the patient’s diagnosis — ensued, the cardiologist asked the question, “Would a computer have gotten the diagnosis correct in this case?” He explained to the group that it was his curiosity that prompted him to ask the patient to unfold the entire story surrounding each episode of his symptoms. While a computer would have used the one-liner “near-syncope after exercising on treadmill” and proceeded along the same algorithm this phrase suggests, this cardiologist felt that he and other humans have an inherent curiosity not possessed by computers and it was this attribute that prompted him to ask the patient to review his history step-by-step, moment-by-moment.
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