Every patient tells a story Medical mysteries and the art of diagnosis

Review by Booklist Review

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.--Chavez, Donna Copyright 2009 Booklist

From Booklist, Copyright (c) American Library Association. Used with permission.

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Review by Publisher's Weekly Review

In her first book, internist and New York Times columnist Sanders discusses how doctors deal with diagnostic dilemmas. Unlike Berton Roueche 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) (c) Copyright PWxyz, LLC. All rights reserved

(c) Copyright PWxyz, LLC. All rights reserved

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Review by Library Journal Review

Sanders, a former journalist who is now a practicing internist and faculty member at Yale University's School of Medicine, writes a regular column for the New York Times Magazine featuring puzzling medical diagnoses. She has, however, a far wider audience as the inspiration and consulting producer for the Fox TV series House. A collection of her Times Magazine columns, Diagnosis reads like a season of House, minus quirky actor Hugh Laurie, but these accounts of anonymous patients with complicated symptoms and doctors demonstrating their diagnostic prowess are riveting nonetheless. Like heroes of detective fiction, the skilled physicians here bring a combination of exceptional knowledge, intuition, and occasional luck to solve mysteries and, often, save lives. Readers will enjoy the unfolding conundrums, but, perhaps more important, they will come away with a new appreciation for the enormous complexity of the human body and the doctors who face its challenges. Fascinating and skillfully written; highly recommended for health sciences and public libraries. [See Prepub Alert, LJ 10/1/08.]-Kathy Arsenault, Univ. of South Florida at St. Petersburg Lib. (c) Copyright 2010. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.

(c) Copyright Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.

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Review by Kirkus Book Review

A doctor's insightful reflections on the disconnect between how physicians should practice and how they actually practice. Although she is a consulting producer for the TV show House, Sanders (Medicine/Yale Univ. School of Medicine) admits that movie and TV doctors make diagnoses seemingly by magic or by uncovering a single overlooked clue. Real doctors listen carefully to patients and examine them, a procedure ignored in fiction but also by many of the current generation of doctors who often prefer tests and advanced technology. "Ultimately," she writes, "the primary work of doctors is to treat pain and relieve suffering." Sanders tells the story of one patient who was feverish and clearly suffering from a severe infection, yet massive intravenous antibiotics weren't helping. A doctor noticed that one of the patient's toes looked gangrenous. When it was amputated, the infection vanished. Patients and doctors yearn intensely for a diagnosisso intensely, in fact, that they may find one that doesn't actually exist. Writes Sanders: "Translating the big, various, complicated, contradictory story of the human being who is sick, into the spare, stripped down, skeletal language of the patient in the bed, and then making that narrative reveal its conclusionthat is the essence of diagnosis." The author also delves into Lyme disease, a tick-born infection that certainly exists but has given rise to a controversial movement in which a small group of patients suffering fatigue, pains, fever and general misery see a small group of doctors who diagnose a chronic Lyme infection that may require a lifetime of treatment. Studies cast doubt on the existence of this ailment, but both patients and doctors dismiss them, as they dismissed past skepticism of diseases such as the Epstein-Barr virus. Fans of Jerome Groopman and Atul Gawande will appreciate this first collection by another astute observer of the medical profession. Copyright Kirkus Reviews, used with permission.

Copyright (c) Kirkus Reviews, used with permission.

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Introduction: Every Patient's Nightmare Barbara Lessing stared out the window at the snowy field behind the hospital. The afternoon sky was dark with yet more snow to come. She looked at the slender figure in the bed. Her daughter, Crystal, barely twenty-two years old and healthy her entire life, was now-somehow-dying. The young woman had been in the Nassau University Medical Center ICU for two days; she'd been seen by a dozen doctors and had scores of tests, yet no one seemed to have the slightest idea of just what was killing her. It all started at the dentist's office. Crystal had had a couple of impacted wisdom teeth taken out the month before. But even after the teeth were gone, the pain persisted. She'd called her mother halfway across the state just about every day to complain. "Call your dentist," she'd urged her daughter. And she had. Finally. The dentist gave her a week's worth of antibiotics and then another. After that her mouth felt better-but she didn't. She was tired. Achy. For the next week she'd felt like she was coming down with something. Then the bloody diarrhea started. And then the fevers. Why didn't you go to the doctor sooner? the trim middle-aged woman scolded her daughter silently. Barbara had gotten a call from a doctor in the emergency room of this suburban hospital the night before. Her daughter was ill, he told her. Deathly ill. She drove to Syracuse, caught the next flight to New York City, and drove to the sprawling academic medical center on Long Island. In the ICU, Dr. Daniel Wagoner, a resident in his second year of training, ushered her in to see her daughter. Crystal was asleep, her dark curly hair a tangled mat on the pillow. And she looked very thin. But most terrifying of all-she was yellow. Highlighter yellow. Wagoner could feel his heart racing as he stood looking at this jaundiced wisp of a girl lying motionless on the bed. The bright unnatural yellow of her skin was shiny with sweat. She had a fever of nearly 103°. Her pulse was rapid but barely palpable and she was breathing much faster than normal despite the oxygen piped into her nose. She slept most of the time now and when awake she was often confused about where she was and how she had gotten there. To a doctor, nothing is more terrifying than a patient who is dying before your eyes. Death is part of the regular routine of the ICU. It can be a welcome relief to the patient, or to his family. Even a doctor may accept it for a patient whose life can be prolonged no longer. But not for a young girl who was healthy just weeks ago. These doctors had done everything they could think of but still there was a fear-a reasonable fear-that they'd missed some clue that could mean the difference between life and death for this young woman. She shouldn't die, but the young resident and all the doctors caring for her knew that she might. Crystal's thin chart was filled with numbers that testified to how very ill she was. Wagoner had been through the chart a dozen times. Virtually every test they'd run was abnormal. Her white blood cell count was very high, suggesting an infection. And her red blood cell count was low-she had barely half the amount of blood she should have. She'd gotten a transfusion in the emergency room and another after she was moved to the ICU, but her blood count never budged. Her kidneys weren't working. Her clotting system wasn't either. Her yellow skin was covered in bruises and her urine was stained deep red. Sometimes, if you just work hard enough to keep a patient alive-to keep the blood circulating, the lungs oxygenating, the blood pressure high enough-the body will be able to survive even a vicious illness. These are the miracles brought by technological advances. Sometimes, but not t Excerpted from Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis by Lisa Sanders All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.

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