Genres: Medical, Diagnosis
Published by Broadway Books
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.