Every patient tells a story: Medical mysteries and the art of diagnosis (pbk)

A riveting exploration of the most difficult and important part of what doctors do, by Yale School of Medicine physician Dr. Lisa Sanders, author of the monthly New York Times Magazine column "Diagnosis," the inspiration for the hit Fox TV series House, M.D. "The experience of being ill can be like waking up in a foreign country. Life, as you formerly knew it, is on hold while you travel through this other world as unknown as it is unexpected. When I see patients in the hospital or in my office who are suddenly, surprisingly ill, what they really want to know is, ‘What is wrong with me?’ They want a road map that will help them manage their new surroundings. The ability to give this unnerving and unfamiliar place a name, to know it—on some level—restores a measure of control, independent of whether or not that diagnosis comes attached to a cure. Because, even today, a diagnosis is frequently all a good doctor has to offer." A healthy young man suddenly loses his memory—making him unable to remember the events of each passing hour. Two patients diagnosed with Lyme disease improve after antibiotic treatment—only to have their symptoms mysteriously return. A young woman lies dying in the ICU—bleeding, jaundiced, incoherent—and none of her doctors know what is killing her. In Every Patient Tells a Story, Dr. Lisa Sanders takes us bedside to witness the process of solving these and other diagnostic dilemmas, providing a firsthand account of the expertise and intuition that lead a doctor to make the right diagnosis. Never in human history have doctors had the knowledge, the tools, and the skills that they have today to diagnose illness and disease. And yet mistakes are made, diagnoses missed, symptoms or tests misunderstood. In this high-tech world of modern medicine, Sanders shows us that knowledge, while essential, is not sufficient to unravel the complexities of illness. She presents an unflinching look inside the detective story that marks nearly every illness—the diagnosis—revealing the combination of uncertainty and intrigue that doctors face when confronting patients who are sick or dying. Through dramatic stories of patients with baffling symptoms, Sanders portrays the absolute necessity and surprising difficulties of getting the patient’s story, the challenges of the physical exam, the pitfalls of doctor-to-doctor communication, the vagaries of tests, and the near calamity of diagnostic errors. In Every Patient Tells a Story, Dr. Sanders chronicles the real-life drama of doctors solving these difficult medical mysteries that not only illustrate the art and science of diagnosis, but often save the patients’ lives. A riveting exploration of the most difficult and important part of what doctors do, by Yale School of Medicine physician Dr. Lisa Sanders, author of the monthly New York Times Magazine column "Diagnosis," the inspiration for the hit Fox TV series House, M.D. "The experience of being ill can be like waking up in a foreign country. Life, as you formerly knew it, is on hold while you travel through this other world as unknown as it is unexpected. When I see patients in the hospital or in my office who are suddenly, surprisingly ill, what they really want to know is, 'What is wrong with me?' They want a road map that will help them manage their new surroundings. The ability to give this unnerving and unfamiliar place a name, to know it--on some level--restores a measure of control, independent of whether or not that diagnosis comes attached to a cure. Because, even today, a diagnosis is frequently all a good doctor has to offer."A healthy young man suddenly loses his memory--making him unable to remember the events of each passing hour. Two patients diagnosed with Lyme disease improve after antibiotic treatment--only to have their symptoms mysteriously return. A young woman lies dying in the ICU--bleeding, jaundiced, incoherent--and none of her doctors know what is killing her. In Every Patient Tells a Story, Dr. Lisa Sanders takes us bedside to witness the process of solving these and other diagnostic dilemmas, providing a firsthand account of the expertise and intuition that lead a doctor to make the right diagnosis.Never in human history have doctors had the knowledge, the tools, and the skills that they have today to diagnose illness and disease. And yet mistakes are made, diagnoses missed, symptoms or tests misunderstood. In this high-tech world of modern medicine, Sanders shows us that knowledge, while essential, is not sufficient to unravel the complexities of illness. She presents an unflinching look inside the detective story that marks nearly every illness--the diagnosis--revealing the combination of uncertainty and intrigue that doctors face when confronting patients who are sick or dying. Through dramatic stories of patients with baffling symptoms, Sanders portrays the absolute necessity and surprising difficulties of getting the patient's story, the challenges of the physical exam, the pitfalls of doctor-to-doctor communication, the vagaries of tests, and the near calamity of diagnostic errors. In Every Patient Tells a Story, Dr. Sanders chronicles the real-life drama of doctors solving these difficult medical mysteries that not only illustrate the art and science of diagnosis, but often save the patients' lives.From the Hardcover edition. From Publishers Weekly In her first book, internist and New York Times columnist Sanders discusses how doctors deal with diagnostic dilemmas. Unlike Berton Rouech? in his books of medical puzzles, Sanders not only collects difficult cases, she reflects on what each means for both patient and struggling physician. A man arrives at the hospital, delirious, his kidneys failing. Batteries of tests are unrevealing, but he quickly recovers after a resident extracts two quarts of urine. An abdominal exam would have detected the patient's obstructed, grossly swollen bladder. The author then ponders the neglect of the physical exam, by today's physicians, enamored with high-tech tests that sometimes reveal less than a simple exam. Another patient, frustrated at her doctor's failure to diagnose her fever and rash, googles her symptoms and finds the correct answer. Sanders uses this case to explain how computers can help in diagnoses (Google is not bad, she says, but better programs exist). Readers who enjoy dramatic stories of doctors fighting disease will get their fill, and they will also encounter thoughtful essays on how doctors think and go about their work, and how they might do it better. (Apr. 14) Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved. From New York Times columnist Sanders says that misdiagnoses account for perhaps as much as 17 percent of medical errors. Some errors result in prolonged or ineffective treatment, while others lead to fatal outcomes. They occur, she says, despite the huge technological advances of recent years. Sometimes the tests and diagnostic tools are to blame; indeed, relying too heavily on test or lab results can produce a false sense of security in both patient and doctor. For all the data they collect, machines lack important components for diagnosis. They cannot hear a patient’s story, touch a patient’s skin, or look into a patient’s eyes. Good diagnosticians are—not unlike TV’s Dr. House—good at puzzles; they employ a large variety of skill sets, including the long-lost art of the thorough physical exam, to solve the mysteries of illness. Besides her own inborn capacity for problem-solving, Sanders’ experience as internist, writer, and consultant to House serves her well here, for absorbing anecdotes generously pepper the exposition. --Donna Chavez Presents An Unflinching Look Inside The Detective Story That Marks Nearly Every Illness-the Diagnosis-revealing The Combination Of Uncertainty And Intrigue That Doctors Face When Confronting Patients Who Are Sick Or Dying--from The Challenges Of The Physical Exam To The Pitfalls Of Doctor-to-doctor Communication, The Vagaries Of Tests, And The Near Calamity Of Diagnostic Errors. Every Patient's Nightmare -- Every Patient Tells A Story -- The Facts, And What Lies Beyond -- The Stories They Tell -- High Touch -- A Vanishing Art -- What Only The Exam Can Show -- Seeing Is Believing -- The Healing Touch -- The Heart Of The Matter -- High Tech -- Testing Troubles -- Limits Of The Medical Mind -- Sick Thinking -- Digital Diagnosis -- The Final Diagnosis. Lisa Sanders. Includes Bibliographical References (p. [257]-269) And Index.