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.
Okay, so this books sounds kind of ehh but it’s actually really interesting. Lisa Sanders presents interesting cases that all revolve around the crafting of a patient’s diagnosis. When a sick person walks into a hospital, they are essentially a puzzle that the doctor must solve by thoroughly investigating and looking for all the clues they can find before reaching to a conclusion that would help treat the malady.
Unfortunately, when the puzzle is a person, you can expect two things. One, no two puzzles will be the same. And two, each puzzle has several layers of complexity. Oh, and also, there is a time limit for how long you can spend with one puzzle since there’s a lot waiting in line to be solved before the day is done. No pressure.
In their haste to clear as many levels as possible, doctors have a tendency to glance over important clues and discard them. Who wants to physically examine the patient? Too time consuming- let’s go directly for a CT or MRI instead. It takes more time and our patient might develop complications as we wait for results, but at least we’d get done with more patients, right?
While reading this book, one of the main things I understood and grasped for myself was the importance of a good physical examination. During the practical exams of my first year of med school, out of seventeen stations, there would be at least one station that had the command of physically examining a patient, while other block examinations would have as many as 10 stations with physical examinations.
At the start, I used to be really squeamish about touching people. I had never touched anyone unnecessarily, let alone a man I had never seen in my life, and the first time I was told “Examine the lymph nodes” I just stared at the examiner, flabbergasted. How was I supposed to prod a stranger’s face and neck for lymph nodes that I knew would not be enlarged? It wasn’t a surprise that I failed that station.
And yet, a year later, I found examinations to be quite simple- I’ve had to palpate and locate the apex beat of the heart on chests, tried to bimanually palpate the kidney in an obese man and prodded people’s feet to find their dorsalis pedis arteries, not to mention swab cotton on legs and hold hands for nerve injuries. So reading this book made all the effort seem like it really was helpful- that I really could save someone’s life just by using my hands to form a quick and likely diagnosis. While such a conclusion cannot be applied everywhere, it still gives me the motivation to keep on learning the steps for each type of examination.
Isn’t that what a book is supposed to do? Inspire you and motivate you? This was definitely that kind of book for me.
I’d give Every Patient Tells a Story a 4/5 and tag it under “Definitely going to re-read again”.
What have you been reading these days?