Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis
Lisa Sanders
Language: English
Pages: 304
ISBN: 0767922476
Format: PDF / Kindle (mobi) / ePub
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.
Healthcare Research and Quality suggested that the likelihood that a doctor will make an important diagnostic error has declined by 25 percent each decade since the middle of the century. It is a testimony to the effectiveness of the new technology of testing we have at our fingertips. But that study also shows that doctors still miss important problems. Of the few autopsies still done, a diagnosis that could have changed the management of the patient—and therefore possibly changed the final
described a particularly difficult episode in his life. “I had been drinking. I was very loud and belligerent that night and my sister, who is probably the closest person to me, walked off and said that she was never going anywhere with me again. Afterward, I went out to the Dumpster and I threw the bottle in that Dumpster and I said that I was never going to drink anymore. I tried to stop on my own, but the next morning when the liquor store was open I was right there buying another bottle. A
accented voice; little uncoordinated bursts of activity from a group of muscle fibers powered by a single nerve fiber. He knew he had found an important clue. Outside the room, Sadigh reviewed what he thought were the important characteristics of the patient and her illness: First, she had been very healthy until now and had spent a lot of time outdoors. She had a profound weakness that affected both legs, but one much more than the other. It was only the thigh and hip muscles that were
able to hear the now familiar lub-dup. This instrument required a different way of listening. This was not going to be as easy as it looked. On another morning, this one nearly two hundred years earlier in Paris, a young physician with the improbably delicate name of René-Théophile-Hyacinthe Laennec was confronted with the problem of examining a plump young woman with chest pain who was suspected of having a diseased heart. The year was 1816. The problem was one of logistics and propriety: how
didn’t have the strength. There were other symptoms too: he was losing weight—twenty pounds in two months. And he was tired. After work, he’d nap, get up for supper, then go back to bed. He also had terrible constipation. Then, just before Christmas, he was shopping with his wife and kept bumping into the shoppers crowding the mall. “I couldn’t make myself go straight,” he said. And his chest felt squeezed, as if he were wearing some kind of girdle around his rib cage. When he began to stagger