April 22, 2011

Book Review: Every Patient Tells A Story

Q: What book have you read lately that feels really relevant?

I have two actually - one is Zeitoun, by Dave Eggers, which tells a story about one family's experience with Hurricaine Katrina, the disaster that was the response to it, and the prejudice against Islamic Americans in the aftermath of 9/11. Until I read Dave Eggers narrative, I don't think I truly grasped just how horrible the US's response to Hurricaine Katrina was. I recommend it highly - it's beautifully written and super easy to read.

The other is maybe more relevant to what I'm learning about right now - "Every Patient Tells A Story" by Lisa Sanders, MD, a columnist for the NYT who was a journalist before going to medical school and is the current medical advisor for the show House, MD. The book is filled with all the puzzles of the cases in her column and on House, but also with some lessons in what skills good doctors have to approach these puzzles. The first lesson, maybe unsurprisingly given everything I've written about on this blog (or just the title of her book), is that really good doctors LISTEN TO THE PATIENT'S STORY.
I'm about to begin my clerkship rotation in Family Medicine, which besides strictly diagnostic fields like Pathology and Radiology, is the division of medicine that does the most problem solving - and unlike Radiology and Pathology - it's reading the PATIENT, not his tissue sample or X-rays. Dr. Sanders' book is awesome in that it's fascinating, but also because it reminds us that being doctors is not so unlike being detectives - that not only do you have to know what the clues mean, but you have to actually notice they're there in the first place.
In her intro, Dr. Sanders says that studies have found that Doctors interrupt patients in the first 11 seconds of their story, and that if they waited, they might get a whole lot more information. My goal for my family medicine rotation is to not interrupt my patients to ask questions unless it's absolutely necessary (still have to stick to some time limits)

"...It [diagnosing a sick patient] is a wayward process
filled with unreliable narratrators - both human and technological -
and yet, despite the unlikeliness,
that answer is often reached and lives are saved"
-Lisa Sanders, MD

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