Reporter-turned-doctor Lisa Sanders writes about patients with elusive diagnoses in her column "Diagnosis" for the New York Times Magazine. The concept of her new book is crystallized in the title: Every Patient Tells A Story - Medical Mysteries and The Art of Diagnosis (Broadway, 2009, ISBN 978-0767922463).
Like her column, the book is primarily composed of stories of patients fighting for a diagnosis. Sometimes the lack of correct diagnosis is because of a rare disease or an unusual presentation of a common illness, but often something has simply been overlooked - sometimes by dozens of doctors.
The book is definitely not focused on "medical mysteries" as in a populistic narrative about the most bizarre medical conditions, but instead it illustrates how even a relatively common illnesses can manifest in puzzling ways. The focus is always on the patients, who despite being "mysteries waiting to be solved" are always human beings struggling with uncertainty.
The Importance of Diagnosis
A few centuries ago, diagnoses were made almost entirely on the basis of symptoms, and usually only an autopsy could reveal the real cause of illness. Of course, at the time the accuracy of such diagnosis was not as important because usually the illness could not be treated in any way.
Nowadays, physicians operate a vast armament of diagnostic tools, from blood tests to CT scans, and no one could deny their usefulness. Yet, paradoxically, in some ways they have had a detrimental effect on the art of the diagnosis.
As a result of technical advances, doctors are now skipping physical examination and even the taking of patient histories. But test results can only be meaningful when the right tests are done, and without a proper history and physical exam, the doctor often does not even understand the main complaint of the patient.
Besides the statistics supporting the importance of proper examination, some of the patient vignettes in the book illustrate all too well the necessity of a physical exam and listening to the patient. Misdiagnosis can prevail for years or lead to death, even though a simple examination would have provided the necessary clues to the correct diagnosis.
Getting a diagnosis can be very important even if nothing can be done about it. This is illustrated all too sadly by the moving description of the author's sister's sudden death, the cause of which remains a mystery despite an autopsy. Eventually the author is able to construct the most likely scenario of what happened, bringing some closure to her grief.
The book also dedicates a chapter to exploring the use of computer software as diagnostic aids, including both highly advanced professional tools as well something more commonly used by the laymen: Google. Such software cannot replace the doctor, but can sometimes help solve a mystery, especially with rare conditions.
Overview
It is rare to come upon a non-fiction book that draws you in so that you just have to read one more page, one more chapter, you just can't let it go. Every Patient Tells A Story is a well-written and thought-provoking book which should be read by all doctors, but it is also thoroughly fascinating for a layman.
See Also
Know Your Chances - Book Review
Every Patient Tells A Story
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