Every Patient Tells a Story

In an ideal world, one does not go to a hospital for whatever reason outside of accident, childbirth, annual checkups, or work. They provide a great and necessary service, of course, no one will doubt this, but nor will anyone disagree with the fact that one must keep one's visits to the hospital and the doctor to as bare a minimum as possible - preferably once a year for an annual check-up. I however, am not among those lucky few. I have been confined to a hospital thrice: twice for dengue, and once for typhoid. I have also been an outpatient twice in recent years (the most recent incident being February of this year), both times for severe gastroenteritis. In all those cases I've watched as doctors take tests, analyze the results, and come to a diagnosis and from there come up with a treatment program that has, in my case, allowed me to survive to this day without anything truly serious happening to me (beyond a deep-seated fear of hypodermic and IV needles).

But I have always wondered: what is going on in the doctor's head? How is he or she able to conclude, based on the tests and my symptoms, just exactly what's wrong with me? I also asked: do they ever get it wrong? I know now, of course, that doctors get it wrong a lot of the time; I've just been lucky that all the doctors who've treated me haven't done so in my case, and, thankfully, in the cases of the people I know and love. But there are a lot of people who haven't been so lucky, and have either suffered more for it, or died for it.

When I came across the book Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis by Lisa Sanders, I was drawn to it for two reasons, and they can be found in the title: “medical mysteries” and “the art of diagnosis.” I am fascinated by biology and medicine, so the idea of reading about medical mysteries was one that appealed to me greatly. On the other hand, I thought this would give me an opportunity to understand how doctors figure out what is wrong with their patients - something I'm invested in knowing, as a potential future patient or caretaker of someone who may be a future patient. Either way, I believed this was a book that was worth reading, so I gave it a shot.

The book is divided into four parts, each divided into chapters. Part One is titled “Every Patient Tells a Story,” and deals with the concept of diagnosis, and why it's so vital in medicine. Part Two is titled “High Touch,” and is about the medical exam: a vital skill that's slowly dying out in medicine as its practiced in the United States. Part Three is titled “High Tech,” and deals with the tests that doctors often have filled out in order to come to a diagnosis for their patients. Part Four is titled “Limits of the Medical Mind,” and deals precisely with what it talks about: the limits of the human brain, and what technology and the medical exam can do to help with those limitations.

As is made obvious from the breakdown above, the book is really a lot more about diagnosis than about medical mysteries, which disappointed me somewhat as I was rather looking forward to a Sherlock Holmes-esque book, like a collection of stories of strange cases and extraordinary diagnoses made by doctors and subsequently collected by Sanders - in short, I was expecting a book that read like a compilation of House, M.D. episodes (especially since Sanders is a consultant on the show), except more realistic. But though Every Patient Tells a Story is not quite what I was expecting it to be, I was still glad to have read it for the insight it provides into the diagnostic process - at least as it is done in the United States.

What Every Patient Tells a Story proves, first and foremost, is that diagnosis is far, far more complicated than it appears on television and movies - and far more prone to error than might be comfortable for some. One would think that, in the twenty-first century, with all the high-tech tests and the enormous database that is the Internet to help doctors along, diagnosis would be a snap - the only thing better would be to have a small, handheld device like Star Trek's tricorder (a similar device is already in development). However, Sanders makes it clear that, while a tricorder would be a lifesaver for many doctors and patients, the act of diagnosis - an oftentimes Sherlockian feat of pulling together disparate clues to form one coherent whole - is something only the human mind can accomplish. Technology can aid this process, but it can only go so far.

And yet, while the human brain is the most powerful analytical tool doctors have when it comes to coming up with diagnoses, it is also potentially the weakest. It does not help that medicine as it's taught and practiced in the United States does not leave much room for improving diagnostic skills: top of the list being the declining use of the physical exam, or the improper use of it. Sanders shows how the declining practice of the physical exam, as well as problems in teaching it, have left American doctors lacking a vital skill that could have allowed them to diagnose an illness properly, or sooner While Sanders is quick to clarify that the physical exam is not infallible, she does emphasize the fact that it teaches necessary skills every good doctor should have - not least that of careful observation, which is crucial in figuring out just what is wrong with the patient. She also includes history-taking as part of this exam, and points out that a lot of doctors really don't know how to take a patient's history down properly.

The first thing I felt about this book was: very perturbed. It's not difficult to understand if a doctor misdiagnoses someone because of machine error on a test, or a lab error, but the fact that the doctor himself or herself can be at fault is rather disturbing. Doctors are human, of course, and one can hardly blame them for making mistakes precisely because they are human, but what this book shows is that sometimes, those mistakes are made due to sheer carelessness. One would think that several years of medical school would whip the carelessness out of future doctors before they're allowed to practice on patients, but apparently that's not always the case.

However, the nature of the book to raise questions in the reader's mind is, I think, also its best quality. Every patient should care whether or not her or his doctor is doing a good job in diagnosing him or her, and every doctor should keep in mind all the ways that she or he can make a mistake, and while some of those ways are unavoidable or cannot be helped, there are many other ways where one can avoid a mistake by taking corrective measures. Also, by pulling back the curtain on the diagnostic process, the reader is given a better understanding of just how that process works, and thus are in a better position to help supply information for an accurate diagnosis (especially since putting together a solid patient history is crucial in coming up with a good diagnosis). It also helps create some sympathy for the doctor, since once the reader understands how difficult it can be to come up with a diagnosis, he or she will be more inclined to not blame the doctor for taking a long time in figuring out what is wrong with oneself or with someone one is caring for.

Aside from the level of the individual doctor-patient relationship, Sanders points out how, on the grander scale of the practice and teaching of medicine itself, there are problems which prevent doctors from coming up with proper diagnoses when they are most needed. In this regard, at least, Sanders points out how some people are trying their best to change the system, trying to regain skills that were or are being lost because they are not longer being taught, or by attempting to introduce new techniques that will make the diagnostic process easier and more reliable. Most importantly, these techniques and improvements are being directed at the doctors themselves - new gadgets are good, of course, but any technology is only as useful as the person using it, which means it's brains that need tweaking and changing.

Overall, Every Patient Tells a Story is a disturbing, but vital, read: disturbing in that it raises some troubling questions that will leave the reader looking askance at her or his doctor, and is likely a book that no hypochondriac should even take a quick skim through. On the other hand, the very thing that disturbs the reader about this book is also the part that makes it very powerful: it shows the reader what goes on when a doctor figures out what is wrong with the patient, and therefore demystifies the process. This can arm the reader with vital information that may help him or her become a better patient - always important when one is trying to get well again, or when one has to care for someone who is ill. This is not for all readers - hypochondriacs have already been mentioned, but anyone with a weak stomach should be forewarned that there are parts that may leave them feeling ill - but it is a good read nonetheless, doctor or (potential) patient.