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. Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDS--three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems. To Err Is Human breaks the silence that has surrounded medical errors and their consequence--but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agenda--with state and local implications--for reducing medical errors and improving patient safety through the design of a safer health system. This volume reveals the often startling statistics of medical error and the disparity between the incidence of error and public perception of it, given many patients' expectations that the medical profession always performs perfectly. A careful examination is made of how the surrounding forces of legislation, regulation, and market activity influence the quality of care provided by health care organizations and then looks at their handling of medical mistakes. Using a detailed case study, the book reviews the current understanding of why these mistakes happen. A key theme is that legitimate liability concerns discourage reporting of errors--which begs the question, "How can we learn from our mistakes?" Balancing regulatory versus market-based initiatives and public versus private efforts, the Institute of Medicine presents wide-ranging recommendations for improving patient safety, in the areas of leadership, improved data collection and analysis, and development of effective systems at the level of direct patient care. To Err Is Human asserts that the problem is not bad people in health care--it is that good people are working in bad systems that need to be made safer. Comprehensive and straightforward, this book offers a clear prescription for raising the level of patient safety in American health care. It also explains how patients themselves can influence the quality of care that they receive once they check into the hospital. This book will be vitally important to federal, state, and local health policy makers and regulators, health professional licensing officials, hospital administrators, medical educators and students, health caregivers, health journalists, patient advocates--as well as patients themselves. First in a series of publications from the Quality of Health Care in America, a project initiated by the Institute of Medicine 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. "To Err is Human breaks the silence that has surrounded medical errors and their consequences - but not by pointing fingers at caring health care professionals who make honest mistakes. Instead, this book sets forth a national agenda - with state and local implications - for reducing medical errors and improving patient safety through the design of a safer health system." "This volume reveals the truth of medical error and the disparity between the incidence of error and public perception of it. A careful examination is made of how the surrounding forces of legislation, regulation, and market activity influence the quality of care provided and then looks at the handling of medical mistakes." "Using a detailed case study, the book reviews the current understanding of why these mistakes happen. Recognizing that legitimate liability concerns may discourage reporting of errors, the book asks, "How can we learn from our mistakes?"" "Balancing regulatory versus market-based initiatives and public versus private efforts, the Institute of Medicine presents recommendations for improving patient safety in the areas of leadership, improved data collection and analysis, and development of effective systems at the level of direct patient care." "This book will be important to federal, state, and local health policymakers and regulators, health professional licensing officials, hospital administrators, medical educators and students, health care-givers, health journalists, patient advocates - as well as patients themselves."--BOOK JACKET. 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. Committee Report on the types of errors committed in health care and the reason of their occurrences, including insights on improving patient safety, recommending preventive mechanism of adverse event resulted from medical management