Book: Every Patient Tells a Story by Lisa Sanders

Pretty interesting book about various aspects of medical diagnosis

Lisa Sanders, M.D.
Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis
Broadway Books, 2009
ISBN: 978-0-7679-2246-3
255 pages

The title of Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis is pretty broad. There isn't a whole lot of medical practice that couldn't be made to fit under it. And the book is in fact a bit miscellaneous. For those people who are (like me) fans of the medical-diagnosis-as-mystery genre, there is some of that here. (The book's dust-jacket mentions that the author, Dr Lisa Sanders, is an advisor for the show House, M.D.) But that's not really what the book is trying to do. (Those fans of that genre who haven't yet should seek out Berton Roueché's books. He pretty much invented the genre, beginning in the 1940s.)

The book's introduction begins with a medical mystery, then Dr Sanders discusses the task of making a diagnosis, and then she tells us a bit about her background. That's not a bad way to begin the book: a story to engage the reader's interest, an analysis of that story that discusses the larger issues it brings up, and then a few words about the person who's telling the stories and doing the analysis here. That's a useful and workmanlike way to begin. If it's not especially elegant, it's probably unreasonable to insist that the author be a literary artist as well as a doctor.

The rest of the book is divided into four parts. The first, "Every Patient Tells a Story", is about the literal and metaphorical stories that patients tell and the ways in which doctors make sense of them. Why exactly should a book with this title have a section of that name? Well, as I said, the book is a bit miscellaneous. The second part, "High Touch", is mostly about the physical examination, its value, and how less and less attention is being given to it. The third part, "High Tech", is a single chapter about Lyme disease. It's about how the disease was discovered, how it's tested for, and some apparently unscientific opinions that some doctors have about it. None of that is especially high tech, but there is an interesting medical mystery there. The book's fourth part, "Limits of the Medical Mind", is about how and why doctors get diagnoses wrong and what may be done to avoid that. There's also an interesting medical mystery there. So the book contains a few interesting medical mysteries and some other information about how diagnoses are done and how they work out that a reader might or might not find especially interesting.

From statements scattered through the book, I get the impression from Dr Sanders that, despite the science and technology that goes into diagnostic tests and treatments, a doctor's interaction with a patient isn't really all that scientific. In the book's last chapter, Dr Sanders tells the story of a patient who looks up her symptoms on the web. Her doctor cheerfully adds her guess to the list of tests to be run. It turns out that she's right and she does have Rocky Mountain spotted fever.

In the same chapter, Dr Sanders describes an infectious disease specialist in Connecticut who needs to figure out what parasite is infecting a women who has recently returned from Africa, In doing so, he consults a database that can be queried to find out what diseases are prevalent in what countries. Apparently, hardly any other doctors do things like that. Indeed, Dr Sanders refers to that simple database as a "digital brain" (p. 225, scare-quotes in the original) rather as though she were a character in a 1960s science-fiction movie.

All that might be nothing more than slightly odd except for something else that Dr Sanders says in the book:

    Physicians are so reluctant to change the way they
    practice medicine that it takes on average seventeen
    years for techniques well established by research --
    such as giving an aspirin to a patient having a heart
    attack -- to be adopted by even half of those in
    practice. In other words, it usually requires an entire
    generation of doctors to turn over for a single new
    practice to become routine, part of medical "tradition."
    (p. 75)

That doctors rarely use computers to assist in diagnosis and aren't likely to start soon of their own accord is a little frightening. It's not exactly what Dr Sanders means to discuss in the book, but I admire her for brining it up. And it is true that that distinction between the science that surrounds the practice of medicine and the way that doctors interact with patients is what Dr Sanders means to discuss in the book. It seems that doctoring is taught and practiced much more like a craft than a science and that makes the book at least pretty interesting.

Posted: Sat - September 19, 2009 at 09:02 PM   Main   Category: