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21 Feb, 2017

Every Patient Tells a Story

/ posted in: Reading Every Patient Tells a Story Every Patient Tells a Story by Lisa Sanders
Published by Broadway Books on 2010-09
Genres: Medical, Diagnosis
Pages: 276
Format: Paperback
Source: Owned
Goodreads

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.


It always amazes me whenever I have an encounter with human medicine that they rarely do a physical exam outside of an ER.  I’ve been to primary care appointments that consist of talking about symptoms and then ordering tests.  This book discusses the decline in the role of hands on contact with patients and what doctors are missing because of it.

As a veterinarian, physical exam is sometimes all we have.  I’d love to run all the tests that human doctors do in order to get the information that they have but that isn’t always financially feasible.  On the other hand I get phone calls from people who have an over-inflated confidence in my clairvoyance.  “Doctor, my dog isn’t eating.  What’s wrong with him?”

The answer in my head every time – “How the $%#@ should I know?  Put him on the phone and let me ask him.”

What I actually say – “That can be a sign of a lot of different illnesses.  I really need to see him to start to figure out what is wrong.”

There is also a lot of information here about taking a good history.  This can be hard because people are ashamed to tell the truth or they misinterpret things and present them as facts that aren’t actually true.  I had a person in last week who seemed very confident in his knowledge about his dog until you actually listened to what he was saying.  Every sentence was complete and utter medical nonsense but it was presented with such conviction that I found myself thinking momentarily that maybe I was wrong and you can see bacteria with the naked eye.  The opposite of this is the person (very common) who waits to tell you the key piece of information that will unlock the puzzle until you have put your stethoscope in your ears.  I have all my assistants trained to tell me everything anyone says while I’m listening to a heart as soon as I take the stethoscope out.  It is always important.

In addition to the author’s discussions about not interrupting patients while getting a history, I will add my favorite history taking advice.  Ask the children.  They see things and they love to have information that adults don’t.  They aren’t shy about sharing it either.

Me, looking at a vomiting dog:  “Did he eat anything unusual that you know of?”

Mom:  “No, he doesn’t do that.”

Kid:  “He ate my Barbie’s arm off yesterday and Daddy’s has been feeding him Slim Jims every day.  We aren’t supposed to tell.”

I don’t know how many domestic disputes have been started by kids coming clean in the vet’s office.

If you aren’t a medical person, this book is still interesting because it contains a lot of medical mysteries.  The author was a consultant for the T.V. show House and writes a column about medical mysteries so she has lots of stories to tell.  I was particularly proud that I knew the answer to the first one in the book.  It had been drilled into me in vet school.  I’ve never seen it in real life but I always think of it.  I’m glad I finally found a use for that piece of knowledge.

 

 

Reading this book contributed to these challenges:

  • Backlist Books
17 Oct, 2016

The Sweet Life in Paris

/ posted in: Reading The Sweet Life in Paris The Sweet Life in Paris: Delicious Adventures in the World's Most Glorious - and Perplexing - City by David Lebovitz
Published by Broadway Books on May 5th 2009
Genres: Nonfiction, Personal Memoirs
Pages: 282
Format: Paperback
Source: Owned
Goodreads
Setting: France

“Like so many others, David Lebovitz dreamed about living in Paris ever since he first visited the city in the 1980s. Finally, after a nearly two-decade career as a pastry chef and cookbook author, he moved to Paris to start a new life. Having crammed all his worldly belongings into three suitcases, he arrived, hopes high, at his new apartment in the lively Bastille neighborhood.
But he soon discovered it’s a different world en France.
From learning the ironclad rules of social conduct to the mysteries of men’s footwear, from shopkeepers who work so hard not to sell you anything to the etiquette of working the right way around the cheese plate, here is David’s story of how he came to fall in love with—and even understand—this glorious, yet sometimes maddening, city.”


This is the book the husband would have written if he lived in France.  He is the person who said halfway through our trip to France that it would be a wonderful country if there were no people in it.  His favorite French vacation story is the time we watched an older French woman beat a disabled British tourist with an umbrella because he didn’t give his seat up to her. He learned that parapluie is umbrella from that incident.

We once had a black, female, French neighbor to whom the husband had to explain several times that while the people in our small town might in fact be both racist and sexist, what was getting her in trouble was being French.  No, it wasn’t ok to park in the fire lane and then cut in line at WalMart because she was parked in the fire lane, for example.

David Lebovitz had this same frustration with French people when he moved to Paris.  Why are they always cutting in line?  Why won’t they help you in a store?  Why does it take so long to accomplish everyday tasks?

This book is hysterically funny.  He is a cookbook author whose new French apartment had a tiny kitchen and suspect plumbing.

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Eventually he learned to adapt and thrive in his new city. He learned to cut in line with the best of them. He started dressing up to take out the garbage. That’s when he knew he was home.


 

There are lots of recipes in this book.  I even made one.  I know!  I’m shocked too.  I almost never make recipes in books.  I made the fig and olive tapenade though and it was scrumptious.  I even took a picture of it as proof but it looks like a glob of clumpy black stuff on some bread.  Yummy food photography is not a skill I have.

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