Medical Mysteries and the Art of Diagnosis
Lisa Sanders, MD
I'm not sure where I first heard of this book, but in preparation for a recent spinal tap procedure, decided I needed a couple books-with-pages to read (as opposed to activities with screens). And it was a good choice. The author consulted for the show House, and it includes a lot of interesting cases she's encountered.
It was good to read about others' journeys through diagnostic limbo. And it provided some good insight into the art and science of the practice of medicine.
But at the same time part of me wanted to say "seriously??" The more I learn, the more I realize that my situation isn't really that rare at all and that makes it even more utterly frustrating. Clearly there should be some sort of procedure or checklist or official guidelines for anyone who has been sick without answers after a given amount of time. Clearly.
My frustrations about medicine aside, there were some good takeaways:
- "The patient's story is often the best place to find [the] clue. It is our oldest diagnostic tool. And, as it turns out, it is one of the most reliable as well. ...anywhere from 70 to 90 percent [of diagnoses] are made on the basis of the patient's story alone"
- "Far too often neither the doctor nor the patient seems to appreciate the importance of what the patient has to say in the making of a diagnosis"
- However: Despite the importance of the patient's story, doctors overwhelmingly interrupt their patients and stop them from giving full accounts of what brings them in.
- "As a result, doctors and patients often have a very different understanding of the visit and the illness".
- The death of the physical exam and the rise of diagnostic testing: "as it turns out, tests and their results are not nearly as crisp and clear as many patients (and doctors) assume them to be .. the testing process can actually slow or sidetrack the diagnostic process in some cases" and "tests don't make a diagnosis - thinking does."
- A story about teaching doctors to be better observers, with a trip to an art gallery
- And an excellent chapter on medical technology and the rise of google.
And it helped further refine my growing plan for
- Guidelines and Procedures for identifying and treating long-term undiagnosed patients (meaning: there should be some.)
- Leveraging new technology -- doctors have rejected older computer-based diagnostic systems because of the cumbersome interface -- having to type everything in for each individual patient. As the Internet of Things grows and becomes better connected, and cloudspace can consolidate records over different practices, hopefully an enterprising startup will build a better mousetrap soon.
- Care Management Coordinators -- Someone to manage a patient's care across doctors and hospitals, who would be able to identify which doctors would need to be seen, schedule appointments, keep an eye on prescriptions, give helpful tips (and possibly hand-holding) during difficult procedures. The role of medical caregiver has grown to the point that it is a full-time job for family members, and often exceeds their abilities. I'm not sure what group this profession would extend from but I'd bet money Nurses or PA's would be best at it.
*MinM: Misadventures in Medicine