Monday, March 14, 2011

Every Patient Tells A Story: Chapter 1

After reading the introduction and Chapter 1, what are some surprises or comments you have on how doctors really diagnose patients? Did you find the reading interesting? Scary? Reassuring? Please share your thoughts.

33 comments:

  1. Ingrid Adamson SmithMarch 14, 2011 at 11:06 AM

    I enjoyed the reading, though I found it alarming. I, like many others, have always sort of blindly put my faith in doctors and the power of science. While I realized that there are always errors in diagnoses and medical problems that cannot be solved, this book forced me into the unhappy realization that medical anomalies happen regularly.

    That said, I did find the book really interesting. I was fascinated by the doctor’s role as a sleuth, and found the stories in the book to be gripping. I also appreciated the emphasis on the importance of a patient’s story, and have since realized the importance of that in my own life – at a recent doctors appointment, I noticed myself how my doctor’s limited understanding of my background made it more difficult for her to help me.

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  2. I found the reading to be fairly reassuring, with the numbers of misdiagnoses going down when studied correctly. But I also found that a lot of what happened in it I had seen before around home. With both of my parents doctors, they spend a lot of time reviewing patients records and stories at home together, trying to figure out the few tricky ones that come in. The balance between getting the real story and listening to the story itself from the patient got me thinking that in difficult cases doctors should go and consult sources close to the patient more often, as a way to balance the story with anything that may have been left out.

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  3. I thought the reading was really interesting! I've honestly never thought about the sleuthing and investigating aspect of being a doctor, but the reading really made me realize how important that step is. Plus, I've always loved mysteries, so I really liked reading about how the doctor pieced together all the information to finally diagnose the patient. I have to admit, it was a little scary to read about all those things the doctors initially missed, but it also made me realize why I have never really enjoyed going to the doctor, especially when something a little more serious has been wrong. I've always felt like the doctor doesn't really understand my background or my problem, and has a hard time figuring out exactly what's wrong. But it was really good for me to finally figure out why I feel that way, and think of how I could maybe fix that in the future.

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  4. I thought that reading this really showed the other side of a diagnosis. It was actually kind of alarming how much thought and detective work goes into just an ER visit. Also what the patient is going through sounds truly awful and so is the fact that no doctor has been able to help her.

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  5. i really enjoyed reading Maria's and Randy's cases. I thought it was very interesting how doctors are able to solve such mysterious cases. I was also surprised at how some patients respond to the unusual diagnosis (plural). The way in which doctors try to solve the cases reminded me a lot about SHerlock Holme' cases.

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  6. I think the most interesting part of the reading was the description of the man who lost the ability to remember anything. I started wondering what it would actually be like completely lose short term memory. Would your brain feel empty not knowing about the immediate past? Might you do something dangerous, like the man in the book did when he repeatedly pulled out his IV because he couldn’t remember why he was in the hospital? More generally, I started wondering what it would be like to have any kind of brain damage. It would be very weird to not be able to process information properly and not have the capacity to correct the mistakes.

    As for the discussion of the diagnostic process, it simply points out what we know to be inherently true in medicine but do not want to believe: that medicine is not an exact science. Doctors can get it wrong. This notion is certainly not reassuring, but it does not come as a surprise to me or significantly change my view of medicine.

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  7. I thought the reading was really interesting and being a diagnostician would be pretty cool. I didn't think House was that close to real life. I was surprised by how Maria Rogers (i think that's her name) responded to her diagnosis and didn't even give it a try. It was crazy how the doctors all pooled their knowledge together and cooperatively worked.

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  8. I didn't find the reading all that alarming, but it definitely opened up my eyes to what really goes on when I go to the doctor's office. Reading this made me question the relationship I have with my doctor and the methods she uses to figure out what's wrong with me. I thought the two cases that were presented in the first chapter were very interesting, and I liked being "on the inside" and knowing not only the key details of the situation, but also the ways the doctors chose to approach it. The difference in the ways the two patients reacted to their diagnosis was fascinating-- While Randy embraced the truth and decided to do something about it, Maria instead refused to better her situation simply because she didn't want to stop her use of marijuana. Seeing the variation in patients' responses to the medical diagnoses was shocking, as I had always assumed that the general public went along with the doctor's decision without question.

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  9. I think the most interesting part of the diagnostic process is how seemingly trivial pieces of information can be of great importance. I found the process of coming to a diagnosis extremely interesting but at the same time scary. the process creates lots of pressure on everyone. Also i was surprised but the patients lack of faith in her diagnosis.

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  10. I found the reading very interesting. It certainly is important to notice the difference between letting a patient's story dictate a diagnosis and using the story as a part of the diagnosis. Also, as seen in the case of pot-loving Maria, should doctors really be obligated to act as salesmen and present their diagnoses?

    I believe this is an important part of medicine that is highlighted well in the reading. I used to think of medicine as a black and white type of activity. Now, it appears as if medicine is much more than that. Its a method of human interaction crucial to healing. As seen from the Yale Medical School first day, doctors forget this every day.

    All in all, I found the reading very interesting and I am excited to read more in the future.

    Thanks
    Sarah Sachs

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  11. Very interesting. Its seems as though if you're not in the vast majority that is treatable with simple diagnostics, you may be in for a rough time. The simple "I think you know what you have" only works up until a point. Having precious days wasted to bureaucratic inefficiencies seems a little unnerving at best.

    The salesman part was also interesting. I can logically see where someone could just reject the doctor's advice, especially if they weren't trusted to the person. The "selling" that goes on also seems akin to new age marketing; paint a nice picture and follow with a disappointment.

    That was fairly pessimistic, all in all.

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  12. I thought it was really interesting about how important a person's history really is in diagnostics. I never really knew that. I think that it was really interesting how Maria Rogers didn't accept the doctor's advice - but I actually think it sort of make sense because she wasn't given any real information about what was causing it - I think that it should be important for a doctor to try to help a patient understand what is wrong with them, so they might accept it more and understand what is causing it. But in this case, even without scientific proof, Maria should have seen by just reasonable thinking that what she had was caused by the marijuana.
    It's scary, really, how suddenly people can get really sick. Like Randy, who was normal and healthy, then suddenly started to be unable to remember anything even from that day. But the difference with him, compared to Maria Rogers, I think, was that "he understood the illness and the prognosis," which helped him accept that that was what was wrong with him. All in all, I think this reading was very interesting :) -lexie

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  13. I thought that the method of diagnosis described in Every Patient tells a Story was very different from that of the doctors I worked with in Children's Hospital Oakland. Although the same amount of care and precision is displayed, the level of detachment is a bit less. I did find that the argument about how a patient's story may affect the diagnostician making the correct call. But overall, the reading seemed interesting, albeit disheartening.

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  14. I really liked the reading. I've watched House a lot, and I always assumed the personal discussions with the patients and the extensive amounts of trial and error in the diagnosis were just ways to dramatize the plot and fill the 45 minutes. Now I realize that these methods are actually really important for real doctors trying to diagnose an illness. It's pretty scary that a doctor missing just one small detail could mean the difference between life and death for a patient. I really didn't understand why the one girl would not accept her diagnosis, especially after seeing other doctors who didn't even offer an alternative, they just said they didn't know what was wrong with her. I've never been as sick as she was, but I can only assume that if I was going through the extreme nausea she was that I would be willing to give up pretty much anything to make myself better.

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  15. I thought the reading was very interesting. I found it rather alarming that doctor's can often miss so much information when diagnosing a patient. I think I thought that the questions doctors ask to give you a diagnosis when you go into the doctor's office would give the doctor all the information they need to give you a proper diagnosis. It was a little scary to read about how wrong doctors can be and how even small, trivial details can play into a proper diagnosis.

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  16. I really liked the part about the difference between letting a patient tell their entire story uninterrupted as opposed to taking the interrogative approach. That makes so much sense to me and I feel like that should be something more clearly instructed in medical school, because clearly it makes a huge difference. How quickly doctors interrupt was also pretty shocking, but also understandable since they want to be efficient. The reading definitely made me a little nervous, because it highlighted how subtle diagnostics are, and how easily clues can be over looked and errors can be made. It's almost more shocking that anyone gets an accurate diagnostic with how many opportunities there are for it to go wrong. I also liked how he mentioned that even with the advances in technology, often the most powerful tool, especially in a crisis situation, is just asking as many people as possible in hopes that someone will find the missing piece. It was a nice reminder that technology can't replace doctors because so much of disease and diagnostic is personal.

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  17. Before reading this chapter, I had not thought much about the importance of the way that a doctor explains a diagnosis to a patient. Now I see that this can make a difference for patients' understanding of their illnesses, their compliance with doctors' orders, and their general outlook and state of mind.
    Learning about the importance of hearing a patient's entire story and the infrequency with which this occurs was also interesting. Listening to someone's whole story instead of asking for the important points is difficult and can seem like a waste of time, but it can be important. This is true in ordinary life, but it is especially true for doctors trying to make a diagnosis. By interrupting patients, they sometimes miss important clues.

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  18. I think it's very interesting that this is only a recent approach to diagnosing patients and that previously it was much more impersonal. It's easy to see what it's important to hear a patient's entire account of what happened rather than just going through the motions of a general questionnaire. It's scary to realize how little time is really allotted to patient-doctor interactions and makes it seem that much more important that the doctor learn all he/she can about the patient in the time they do have together. I think exams would definitely benefit from being longer, but that's obviously an issue that neither the doctor nor the patient have much control over. What I also found really interesting was the stress the book put on the necessity of the doctor to be able to "retell" the patients story, once a diagnosis has been made, in a way that the patient both understands and can work into their lifestyle. It makes sense that this would increase the percentage of patients that follow through with their treatments and therefore are able to improve.

    (sorry this is late, my book just came in the mail yesterday.)

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  19. Sander's ability to make the intense situations of extreme and life threatening cases interesting, engaging, and suspenseful made chapter one go by faster than most pieces of literature I have had to read this year. I am concerned, just like the formulaic approach to writing TV scripts, that the book will feature the same, "we have no idea whats going on...we still have no idea whats going on...you're not telling us what!?...oh, now I think I know what's going on" process over and over again. The most alluring part of the first chapter was Sander's analysis of the power of fear as a component of sickness. Too often I feel that the action alone of sitting at home, watching bad television, and getting no fresh air makes me more sick than the flu I might have. This would explain that it is the mental state of sickness has physical manifestations. Sander's uses the juxtaposition of pain and suffering to look at this same point. Pain, she states, can be endured and even treated. While the self perpetuating degradation of suffering leaves people hopeless and without a easy way out. She says, "there are no drugs to treat suffering." Treatment interests me on a psychological level more than on a medical level, so I hope the book continues to explore this side of sickness and diagnosis.

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  20. Reading this chapter helped me realize how important the patient's story truly is. I also liked the idea that the doctor had to not only listen to the entirety of the patient's story, but also incorporate the diagnosis into the patient's life in order to convince the patient. Though the failures disturb me, the successes relieve me to a certain extent. I now also feel pressured to ensure that the doctor listens to my story...

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  21. This book really can appeal to everyone. Even though I am pretty disconcerted by blood, arteries, and illnesses, I am still interested. Reading these anecdotes, it seems like anyone I know could be afflicted by a rare disease (the story about the man suddenly losing his memory was especially sobering!). It's comforting to know that people out there are refining the art of diagnosis to prevent more and more unnecessary deaths. Though I could never take part in it myself, I think that medicine is the most important profession in the world. Getting insights into how doctors use symptoms to unravel these cases is fascinating.

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  22. After reading the Chapters, I was surprised and very intrigued more on the prognosis rather than the diagnosis of the disease. I knew that doctors can only so far predict what will happen to their patient, but I didn't know how they would approach their patients if their problems didn't fade away. This book has also nagged on me to watch House, which I originally thought of as purely fiction; there was no way that doctors could react like that to a patient. Yet, after reading and realizing that yes, Every Patient does, in fact, have a story to tell, I have now started to pay more attention to the descriptions of the patient's history during the show (and of course, in real life). Like any doctor, a writer also has to choose his words carefully. In both professions, the minute details lay the foundation for the whole story; there must be a reason why a writer uses a certain prose which is akin to that there also must be a reason for a doctor to give such a diagnosis. I've been in a situation where the doctor thought my issue was not as worse as it actually was; this later became an issue where I had to travel around to various doctors to find out what exactly was wrong with me (the case has yet to be solved). I look forward to finishing the book in a very short time, and I plan to find Sander's article that she writes daily. Hopefully, I'll find more stories to satisfy my appetite.

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  23. I found the reading to be extremely interesting. I didn't find the diagnosis method to be really surprising because I attended a medical program during the summer (2010). I attended a few lectures about the diagnosis process and how many patients often lie about their medical history. Nevertheless, I found the reading to be refreshing. The diagnostic process was pretty interesting and I was surprised how the interrogative approach was the primary approach to diagnosing patients until recently. Although it may seem tedious, listening to a patient's full story uninterrupted can result in a correct diagnosis in the most efficient way possible. I think this method should be reinforced in medical school as it results in more quick, correct diagnoses.

    I found Maria Roger's story to be particularly interesting. Her case showed me how seemingly unimportant pieces of information can play in a diagnosis. I was also pretty shocked that Maria didn't accept the doctor's diagnosis. Many members of my extended family are doctors, so I've pretty much grown up trusting the medical world without any questions. Doctors under years of rigorous schooling and training, so I find it hard to comprehend why Maria would question or refuse the explanation of her illness, especially as she has no experience in the field of medicine. Her symptoms were so terrible that you would think she would do anything to recover.

    Overall, I really enjoyed the reading and look forward to reading more of the book!

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  24. I was surprised by the level of difficulty involved in the medical field. I have never really thought about it, considering my lack of any real medical problems. I thought it was really interesting how doctors are less trained to know all the facts and more trained to understand how to deal with their situations, how they must be able to deal with pressure and constant uncertainty. Of course medical knowledge is vital, but careful attention and logical thinking are just as important. From this book, it seems that doctors must not only be smart, but good with people, almost manipulating them.

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  25. THIS IS CATHERINE COVE (I am having difficulty posting from my account)
    I enjoyed the first chapter of Every Patient Tells a Story because it helped highlight the complexities associated with diagnosing an illness. Making a diagnosis is not as straightforward as I had previously assumed it to be. It seems unlikely that patients would lie about their medical history when they have so much at stake, but the book says that it is a fairly common occurrence. Even when patients are not deliberately lying, they often omit facts that they believe are trivial, unrelated or insignificant. When doctors do not know what they are looking for, it is hard for them to know what types of questions to ask the patient. On the other hand, when doctors already have an opinion of what a patient might have, they tend to ask patients very specific questions, and sometimes they overlook significant factors. In the story of Maria Rogers, I thought it was surprising that she was so unwilling to accept the diagnosis that the doctor gave her. I would have thought that Maria would have been happy with receiving any possible reason for her uncontrollable vomiting. I myself suffer from an extreme fear of vomit, and I would go to any lengths to stop such a disgusting illness, no matter how greatly it affected my everyday life. This story showed how much power a patient has over his or her diagnosis. I found it both eye opening and a little troubling.

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  26. Reading Maria Rogers's story was VERY FRUSTRATING. I can't believe that she wouldn't listen to the doctors/ she thought she was knew more than them. Maybe her brain was fried from all the weed/ maybe more potent drugs she did. Also, maybe the prospect of losing that chemical stimulation from the drugs was too much for her. Either way, her brain was probably very altered/effected by weed since she had the rather extreme condition of vomiting which the doctors thought was triggered by her brain. It's interesting how much small facts/tidbits from the patient's life (eg taking warm showers) helps doctors diagnose rare diseases, and how much patients reluctance to discuss information can influence the diagnosis, that girl with herpes who went to the doctor to confirm that her herpes was because of doing "exercises on a hard floor."

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  27. After reading the introduction and first chapter of Sanders' book I was completely enthralled by what she recounted about how doctors diagnose their patients. I loved learning about both Maria and Randy's shocking stories about their ailments, their vastly different experiences in the hospital, and how their doctors were ultimately able to determine a diagnosis for both patients. The opposite reactions that both of these patients had towards their diagnosis was striking. Both of these stories really enforce the importance, and necessity of a doctor relating a patient's medical info in a way that will allow the patient to connect and truly understand to what the doctor is saying. Most importantly, this understanding will help foster the patient's healing because of the trust between a doctor and her patient. However, the reading also began to address the far more prevalent disconnect between patients and their doctors. I was shocked to learn the statistic of how often doctors interrupt patients and how easy it is for patients to misconstrue their stories due to their fear or the misguidance of leading questions that their doctors may ask. I am very excited to continue reading because this book provides a unique and fascinating window into what a differential diagnosis truly is in a way that people may not otherwise have access to.

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  28. I thought that it was very interesting that the vital piece of information for Maria's diagnosis was that hot showers helped her nausea. I would have thought that her doctor should have been able to make a diagnosis off her test results. I also found it pretty shocking that the doctor literally googled an odd symptom of her patient and found the most likely cause of her vomiting. I thought that most diagnosis were made from physical observations and test results. However in the case of Maria and the girl with herpes, just listening to there full background history proved to be vital in making the diagnosis. Its kinda scary that some doctors can overlook a diagnosis by rushing patients and from being stressed all the time.

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  29. I though that the diagnosis was interesting. It was interesting that patients have such a large impact on the diagnosis process, because the information that they tell their doctors drastically affects how accurate a diagnosis can be. However, what I thought was more interesting was the way that patients responded to the diagnosis. Maria decided to ignore her diagnosis in order to continue smoking pot, which seems astonishing. It is amazing that drug addictions are strong enough to encourage someone, like Maria to choose to keep smoking pot despite all the horrible symptoms that she was experiencing.

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  30. This is Matt Barber and David Sasson (he is having difficulty posting on his account, so we are working together).

    We found it interesting that one small fact or past experience can extremely change a diagnosis. As with Maria, the simple fact that warm showers helped the doctors assess a different disease, when at first they thought her vomiting problem was neurologically related. With Randy, since rashes and joint pains were not present, the doctors were able to rule out Lupus, even though it may have fit his other symptoms. Through the CT and biopsy, the doctors were then able to discover his final diagnosis, Hodgkin's lymphona, and paraneoplastic syndrome. These patients show how doctor's need to take many perspectives and tests into view before making a final diagnosis.

    "75% of what doctors do is management of the diagnosis. 10% is the actual diagnosis, whereas the other percentage works with dealing with inter-personal relationships with the patient, whether with them, friends or family. Not only that, but a big piece is also convincing patients what to do, a necessary trait for doctors once they already have the diagnosis and ideas of treatment." -Thomas Barber, M.D.

    In the book, Maria's doctor should have connected better with Maria. She didn't relate the diagnosis and treatment methods with Maria's life, thus losing Maria's trust.

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  31. For me, the craziest thing was how much research, thinking, and detective work goes to into just one diagnosis. I thought that after taking one or two tests it was pretty obvious what the problem was and how to fix it. The story in the introduction really opened my eyes as to how much is required of doctors. I guess this makes me feel a little alarmed, for the doctor could have just as easily made the wrong diagnosis. All in all, it just makes me respect the difficult jobs that doctors have to deal with all the time.

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  32. After reading chapter one of EPTAS I found it quite interesting just how much information a doctor needs to obtain about a patient in order to make a proper diagnosis. If one detail is withheld by a patient the doctor could come to the incorrect conclusion. The inconclusiveness of the entire process was little bit shocking to me. I think it’s scary how the/a patient can assume they just have a minor issue and keep going on with their life rather than fully address the issue with doctor (in the case of the girl who kept throwing up). I was also surprised that the doctor had to Google her symptom, that was a bit sketchy.

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  33. I thought the reading was interesting, but not because of the patient. I thought the diagnostic process was more interesting. I was shocked to discover how important diagnosing the illness was. They book made it seem like missing a single detail or withholding any information from the doctor would make all the difference in the world. They also went on to say that that doctors rely heavily on the diagnosis of the patient when they prescribe medicine. After hearing how important the diagnosis is, I was surprised and a little angry that doctors in general don't pay as much attention to the patient's explanation of their symptoms.

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