Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis » (Reprint)

Lisa Sanders, M.D. is an Assistant Clinical Professor at the Yale University School of Medicine and a clinician educator in Yale’s Primary Care Internal Medicine Residency program. Dr. Sanders writes the popular “Diagnosis” column, which appears monthly in The New York Times Magazine.

Her column was the inspiration for the acclaimed Fox television show “House M.D.,” and she currently serves as technical advisor for the show. Although teaching about clinical reasoning and diagnostic error is her first love, much of her research and practice focus on the treatment of overweight and obese patients She is the author of The Perfect Fit Diet: How to Lose Weight, Keep it Off And Still Eat the Foods You Love.

Before entering medical school, Sanders was an Emmy Award-winning producer at CBS News, where she covered medicine and health and she also worked as a producer at ABC and NBC News. She lives in New Haven, Connecticut.

A riveting exploration of the most difficult and important part of what doctors do, by Yale School of Medicine physician Dr. Lisa Sanders, author of the monthly New York Times Magazine column "Diagnosis," the inspiration for the hit Fox TV series House, M.D.

"The experience of being ill can be like waking up in a foreign country. Life, as you formerly knew it, is on hold while you travel through this other world as unknown as it is unexpected. When I see patients in the hospital or in my office who are suddenly, surprisingly ill, what they really want to know is, ‘What is wrong with me?’ They want a road map that will help them manage their new surroundings. The ability to give this unnerving and unfamiliar place a name, to know it–on some level–restores a measure of control, independent of whether or not that diagnosis comes attached to a cure. Because, even today, a diagnosis is frequently all a good doctor has to offer."

A healthy young man suddenly loses his memory–making him unable to remember the events of each passing hour. Two patients diagnosed with Lyme disease improve after antibiotic treatment–only to have their symptoms mysteriously return. A young woman lies dying in the ICU–bleeding, jaundiced, incoherent–and none of her doctors know what is killing her. In Every Patient Tells a Story, Dr. Lisa Sanders takes us bedside to witness the process of solving these and other diagnostic dilemmas, providing a firsthand account of the expertise and intuition that lead a doctor to make the right diagnosis.

Never in human history have doctors had the knowledge, the tools, and the skills that they have today to diagnose illness and disease. And yet mistakes are made, diagnoses missed, symptoms or tests misunderstood. In this high-tech world of modern medicine, Sanders shows us that knowledge, while essential, is not sufficient to unravel the complexities of illness. She presents an unflinching look inside the detective story that marks nearly every illness–the diagnosis–revealing the combination of uncertainty and intrigue that doctors face when confronting patients who are sick or dying. Through dramatic stories of patients with baffling symptoms, Sanders portrays the absolute necessity and surprising difficulties of getting the patient’s story, the challenges of the physical exam, the pitfalls of doctor-to-doctor communication, the vagaries of tests, and the near calamity of diagnostic errors. In Every Patient Tells a Story, Dr. Sanders chronicles the real-life drama of doctors solving these difficult medical mysteries that not only illustrate the art and science of diagnosis, but often save the patients’ lives.

Publishers Weekly

In her first book, internist and New York Times columnist Sanders discusses how doctors deal with diagnostic dilemmas. Unlike Berton Roueché 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)

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Author's Note ix

Introduction: Every Patient's Nightmare xi

Part 1 Every Patient Tells a Story

1 The Facts, and What Lies Beyond 3

2 The Stories They Tell 22

Part 2 High Touch

3 A Vanishing Art 39

4 What Only the Exam Can Show 53

5 Seeing Is Believing 77

6 The Healing Touch 109

7 The Heart of the Matter 129

Part 3 High Tech

8 Testing Troubles 167

Part 4 Limits of the Medical Mind

9 Sick Thinking 193

10 Digital Diagnosis 216

Afterword: The Final Diagnosis 239

Acknowledgments 253

Notes 257

Index 271