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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.
- Sales Rank: #11951 in Books
- Published on: 2010-09-21
- Released on: 2010-09-21
- Original language: English
- Number of items: 1
- Dimensions: 8.00" h x .70" w x 5.10" l, .46 pounds
- Binding: Paperback
- 304 pages
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 Booklist
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
Review
"Lisa Sanders is a paragon of the modern medical detective storyteller. The tales here crackle with suspense. But what sets her apart is her Holmes-like eye for the clues–and her un-Holmes-like compassion for those who suffer."
—Atul Gawande, author of Better: A Surgeon’s Notes on Performance and Complications: A Surgeon’s Notes on an Imperfect Science
"Dr. Lisa Sanders is the most acute observer of health care in America. In this compelling book, she opens the black box of diagnosis and lets us look inside."
—Ian Ayers, author of Super Crunchers: Why Thinking-by-Numbers Is the New Way to Be Smart
"Not ‘whodunit’ so much as ‘whatdunit,’ Lisa Sanders’s book brilliantly conveys the sleuthing that lies at the heart of medical diagnosis. But this is more than a set of suspenseful tales unfolded by a skilled storyteller. Amid all the flash and dazzle of the modern doctor’s high-tech armamentarium, Dr. Sanders finds that all too often it is the ancient skills, of touch and of attentive listening, that serve the physician, and her patients, best of all. Enlightening for patients, essential for practitioners, this book should be read by every doctor. I’m praying that mine will."
—Geraldine Brooks, author of March, People of the Book, and Nine Parts of Desire
"Lisa Sanders has written a beautiful, thought-provoking book about the sine qua non of medical care–diagnosis. She tells stories about great diagnostic triumphs and explains both the pitfalls and successes of diagnosis. Her patient stories captivate the reader as we try to solve the unfolding mystery. Through these stories we understand and remember the importance of accurate diagnosis."
—Robert Centor, MedRants.com
"Every Patient Tells a Story is a must-read for anyone who has ever been a patient or is a doctor. Written by a physician I respect and a writer I love, the book is filled with intriguing diagnostic dilemmas that will draw you in, and with human stories that will linger in your mind–and heart–long after you are done."
—Pauline W. Chen, author of Final Exam
From the Hardcover edition.
Most helpful customer reviews
69 of 71 people found the following review helpful.
A thrilling inside tour of medicine that non-M.D.s will love,too
By B. C.
Every patient would love a look inside her physician's head to glimpse that meticulous moment-to-moment process that yields a great--even life-saving--diagnosis. That's exactly what EVERY PATIENT TELLS A STORY does. Bless Dr. Sanders for having the heart, wisdom and eloquence to lay open the M.D. brain for all of us nervous lay people who, at those moments of health crisis, can only pray we've picked a good doc.
It turns out that the things we patients secretly crave from our doctors--eye contact, focused conversation, LISTENING, the reassuring touch of the physician's educated hands on our painful abdomens or dislocated shoulders--are also the most vital tools of a truly great diagnostician. Of course we're grateful for medical technology, but as Dr. Sanders so brilliantly argues, these technical advancements work best when physicians' own powers of observation--and yes, intuition--are also fully engaged.
The last chapter is a dramatic departure from the rest of the book. Here Dr. Sanders tells us a very personal diagnosis story, one involving the untimely death of her younger sister. The gift of such an intimate conclusion reminds the reader of the humane impulse that so clearly motivated its author on every preceding page.
44 of 46 people found the following review helpful.
compelling and yet worrisome story about medicine
By mikemac9
From the blurbs on the book I expected this to be for Internal Medicine what the series of books by the late Dr. Harold Klawans was for Neurology, a set of stories about clinical puzzles and their resolution. The publisher sells this book short, because while these vignettes are present (albeit in briefer form than in Klawans books), there is so much more! This book is really a grand tour of the role of the physical exam in medicine, through all its stages. You'll learn how doctors are taught the process, its declining role in current practice as hi-tech tests replace doctors looking, listening, and touching. You'll find out why tests can't completely replace a skilled doctor conducting a careful exam, the pressures on doctors to skimp or omit the exam, even the role technology can play in helping doctors evaluate alternative approaches. All accompanied by illustrative stories to pique your interest.
This book may be a disappointment to those led by the title and blurbs on the covers to expect a book just about diagnostic stories, something akin to a compendium of the monthly "Vital Signs" column in Discover magazine. For those concerned about health care issues, though, it provides a thorough background into an area of medicine and insight into the debate over the growing use of expensive tests. The worrisome aspect of this book comes because once you understand the importance of a careful exam, you realize that not only is it being abandoned wholesale by the profession even when it should be retained, you have no way to know whether your doctor is any good at it.
One positive sign related in this book is the renewed interest among medical faculty of the importance of careful physical exams. Doctors must now show proficiency in order to be licensed. Even practicing doctors are seeking out additional training, as Dr. Sanders does when she attends a class on heart sounds. Even this seems incomplete to me; after the training the doctors test much better than before, but do they keep that improvement 6 months or 6 years later? I wonder why they don't leave the class with a program that has hundreds of versions of the sounds they've learned on it so that they can test/refresh their skill once a month or so.
The last takeaway from this book, and it's useful reminder, is that medicine is an art. Not only are doctors imperfect, so is knowledge and diagnosis of disease. People get things, debilitating things, and nobody can figure out what they have. This book serves to point out that a skilled doctor taking a careful look may be able to solve some of the mysteries.
25 of 26 people found the following review helpful.
Fantastic
By M. Hyman
There are books where, from the first page, you just know you are going to like it. This is one of them. As a huge fan of the tv show House, I was excited to read a book by the author, who is a technical advisor to the show. She provides a mix of stories of the type portrayed in the show.. medical mysteries. But, unlike the fictional version, she discusses the science behind the diagnoses, and what goes wrong. So this book is in part a book about medical diagnosis, discussing various techniques that are used, and in part it is very much a critique of medical diagnosis, describing the loss of valuable tools with the current deemphasis on hands on examinations. She includes stories of triumphs, but more importantly, shows how many diagnoses went wrong, and suggests improvements.
Thus, this book is both about medical diagnoses, but it also raises important questions about medical practices that are of interest generally, but i believe would be of interest to and resonate with doctors as well.
The book is very well written. It is clear, concise, and personal.
It also gives a nice depth for how I will look at House when the new season begins. (Perhaps with more medicine and less drama, I hope).
My biggest complaint about the book? Sequel isn't ready yet. Finished it in a day, and would like to read more.
Altogether, a great read. Get it.
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