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Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis [Hardcover]

Lisa Sanders
4.5 out of 5 stars  See all reviews (2 customer reviews)

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Book Description

Aug. 11 2009
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.

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Review

"Lisa Sanders is a paragon of the modern medical detective storyteller. The tales here crackle with suspense. But what sets her apart is her Holmes-like eye for the clues–and her un-Holmes-like compassion for those who suffer."
—Atul Gawande, author of Better: A Surgeon’s Notes on Performance and Complications: A Surgeon’s Notes on an Imperfect Science

"Dr. Lisa Sanders is the most acute observer of health care in America. In this compelling book, she opens the black box of diagnosis and lets us look inside."
—Ian Ayers, author of Super Crunchers: Why Thinking-by-Numbers Is the New Way to Be Smart

"Not ‘whodunit’ so much as ‘whatdunit,’ Lisa Sanders’s book brilliantly conveys the sleuthing that lies at the heart of medical diagnosis. But this is more than a set of suspenseful tales unfolded by a skilled storyteller. Amid all the flash and dazzle of the modern doctor’s high-tech armamentarium, Dr. Sanders finds that all too often it is the ancient skills, of touch and of attentive listening, that serve the physician, and her patients, best of all. Enlightening for patients, essential for practitioners, this book should be read by every doctor. I’m praying that mine will."
—Geraldine Brooks, author of March, People of the Book, and Nine Parts of Desire

"Lisa Sanders has written a beautiful, thought-provoking book about the sine qua non of medical care–diagnosis. She tells stories about great diagnostic triumphs and explains both the pitfalls and successes of diagnosis. Her patient stories captivate the reader as we try to solve the unfolding mystery. Through these stories we understand and remember the importance of accurate diagnosis."
—Robert Centor, MedRants.com

"Every Patient Tells a Story is a must-read for anyone who has ever been a patient or is a doctor. Written by a physician I respect and a writer I love, the book is filled with intriguing diagnostic dilemmas that will draw you in, and with human stories that will linger in your mind–and heart–long after you are done."
—Pauline W. Chen, author of Final Exam

About the Author

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.

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4.0 out of 5 stars More Bookish Thoughts... May 30 2011
By Reader Writer Runner TOP 50 REVIEWER
Format:Paperback
I've been reading a lot of non-fiction lately only because of what's become available from my library holds list. I enjoy the break from novels, though, and find that well-written books exploring the "real world" can be every bit as engaging. That's certainly the case with Lisa Sanders' first work. Dr. Sanders (Yale Med. Center) writes a fascinating monthly column for the New York Times magazine called "Diagnosis," in which she describes the process of diagnosing patients with strange, unpredictable and inexplicable symptoms. Every Patient Tells a Story details the role of the physical exam in medicine, describing how doctors are taught the process, how hi-tech tests are replacing looking, listening and touching and how many medical errors are made when doctors neglect to either perform an exam or run appropriate tests. The most interesting parts of the book are the specific case studies: everything from a patient who self-diagnoses her Rocky Mountain Spotted Fever to one who lives for two years thinking she has Chronic Lymes Disease only to finally be diagnosed with a rare form of arthritis. Ultimately, the book argues that medicine is an art. Doctors are human and, thus, fallible, which provides no great comfort but at least makes the reader more sensitive to the intricacies of diagnosis.
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5.0 out of 5 stars Every Patient Tells a Story Sept. 8 2010
Format:Hardcover
Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis
Lisa Sanders, M.D.
New York: Broadway Books, 2009, $29.95, 276 pgs.

Lisa Sanders' book is a riveting exploration of the most difficult and most
important thing that doctors do: diagnose the disease of a patient. As Sanders
explains through her book, diagnosis is not so much based on a scientific
formula as it is an art that takes many years to develop. Even experienced
physicians and specialists sometimes have a difficult time effectively and
accurately diagnosing patients. A patient's experience of being ill is also mired
with complexity and turbulence. And it is no wonder since the experience of
being ill is unique to each patient. The patient may have a really difficult time
to come to terms with his/her illness. When a patient becomes ill, life as (s)he
knew it is on hold. And this is really scary for most patients.

This is especially the case if patients become ill suddenly. Patients struggle
to come to terms with their illness. Doctors have a difficult time to sometimes
diagnose the disease effectively. Yet, never in the history of the medical
profession have doctors had the knowledge, and the skills that they have today
to effectively diagnose illness. And yet mistakes are made, diagnoses missed,
and symptoms or tests are sometimes misunderstood. In this high-tech world
of modern medicine, Sanders shows that knowledge, while essential, is not
sufficient to unravel the complexities of illness. She presents a look inside the
story that marks every illness.
Read more ›
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Most Helpful Customer Reviews on Amazon.com (beta)
Amazon.com: 4.4 out of 5 stars  114 reviews
56 of 58 people found the following review helpful
5.0 out of 5 stars A thrilling inside tour of medicine that non-M.D.s will love,too July 29 2009
By B. C. - Published on Amazon.com
Format:Hardcover
Every patient would love a look inside her physician's head to glimpse that meticulous moment-to-moment process that yields a great--even life-saving--diagnosis. That's exactly what EVERY PATIENT TELLS A STORY does. Bless Dr. Sanders for having the heart, wisdom and eloquence to lay open the M.D. brain for all of us nervous lay people who, at those moments of health crisis, can only pray we've picked a good doc.
It turns out that the things we patients secretly crave from our doctors--eye contact, focused conversation, LISTENING, the reassuring touch of the physician's educated hands on our painful abdomens or dislocated shoulders--are also the most vital tools of a truly great diagnostician. Of course we're grateful for medical technology, but as Dr. Sanders so brilliantly argues, these technical advancements work best when physicians' own powers of observation--and yes, intuition--are also fully engaged.
The last chapter is a dramatic departure from the rest of the book. Here Dr. Sanders tells us a very personal diagnosis story, one involving the untimely death of her younger sister. The gift of such an intimate conclusion reminds the reader of the humane impulse that so clearly motivated its author on every preceding page.
36 of 38 people found the following review helpful
5.0 out of 5 stars compelling and yet worrisome story about medicine July 27 2009
By mikemac9 - Published on Amazon.com
Format:Hardcover|Vine Customer Review of Free Product
From the blurbs on the book I expected this to be for Internal Medicine what the series of books by the late Dr. Harold Klawans was for Neurology, a set of stories about clinical puzzles and their resolution. The publisher sells this book short, because while these vignettes are present (albeit in briefer form than in Klawans books), there is so much more! This book is really a grand tour of the role of the physical exam in medicine, through all its stages. You'll learn how doctors are taught the process, its declining role in current practice as hi-tech tests replace doctors looking, listening, and touching. You'll find out why tests can't completely replace a skilled doctor conducting a careful exam, the pressures on doctors to skimp or omit the exam, even the role technology can play in helping doctors evaluate alternative approaches. All accompanied by illustrative stories to pique your interest.

This book may be a disappointment to those led by the title and blurbs on the covers to expect a book just about diagnostic stories, something akin to a compendium of the monthly "Vital Signs" column in Discover magazine. For those concerned about health care issues, though, it provides a thorough background into an area of medicine and insight into the debate over the growing use of expensive tests. The worrisome aspect of this book comes because once you understand the importance of a careful exam, you realize that not only is it being abandoned wholesale by the profession even when it should be retained, you have no way to know whether your doctor is any good at it.

One positive sign related in this book is the renewed interest among medical faculty of the importance of careful physical exams. Doctors must now show proficiency in order to be licensed. Even practicing doctors are seeking out additional training, as Dr. Sanders does when she attends a class on heart sounds. Even this seems incomplete to me; after the training the doctors test much better than before, but do they keep that improvement 6 months or 6 years later? I wonder why they don't leave the class with a program that has hundreds of versions of the sounds they've learned on it so that they can test/refresh their skill once a month or so.

The last takeaway from this book, and it's useful reminder, is that medicine is an art. Not only are doctors imperfect, so is knowledge and diagnosis of disease. People get things, debilitating things, and nobody can figure out what they have. This book serves to point out that a skilled doctor taking a careful look may be able to solve some of the mysteries.
20 of 21 people found the following review helpful
5.0 out of 5 stars Fantastic July 31 2009
By M. Hyman - Published on Amazon.com
Format:Hardcover|Vine Customer Review of Free Product
There are books where, from the first page, you just know you are going to like it. This is one of them. As a huge fan of the tv show House, I was excited to read a book by the author, who is a technical advisor to the show. She provides a mix of stories of the type portrayed in the show.. medical mysteries. But, unlike the fictional version, she discusses the science behind the diagnoses, and what goes wrong. So this book is in part a book about medical diagnosis, discussing various techniques that are used, and in part it is very much a critique of medical diagnosis, describing the loss of valuable tools with the current deemphasis on hands on examinations. She includes stories of triumphs, but more importantly, shows how many diagnoses went wrong, and suggests improvements.

Thus, this book is both about medical diagnoses, but it also raises important questions about medical practices that are of interest generally, but i believe would be of interest to and resonate with doctors as well.

The book is very well written. It is clear, concise, and personal.

It also gives a nice depth for how I will look at House when the new season begins. (Perhaps with more medicine and less drama, I hope).

My biggest complaint about the book? Sequel isn't ready yet. Finished it in a day, and would like to read more.

Altogether, a great read. Get it.
69 of 92 people found the following review helpful
1.0 out of 5 stars Diagnosis: Boring, Derivative, and Unorganized July 20 2009
By Geneva Lewis - Published on Amazon.com
Format:Hardcover|Vine Customer Review of Free Product
First of all, let me state that I love medical literature and find it quite readable and fascinating. Dr. Lisa Sanders has impressive credentials and is a consultant for the television medical drama "House". Therefore, I was excited to learn from this book but after the first few chapters I felt considerably deflated as my expectations met reality. It appears to have been conceived in a stop-start fashion, without a cohesive, readable narrative or comprehensive organization strategies. It feels as if it were created on a few red-eye flights from L.A. to New York City with a laptop, generous use of existing historical texts (which are cited) and notes from medical conventions and colleagues. The book lacks readability because of its disjointed format and the inability to decide what it is and how the distinct elements can be combined logically: medical case studies, history of medicine, examining cognition of physicians be it training or practice-based. Four elements are at work: 1) doctor/patient stories 2) details of past and current medical diagnostic training 3) concepts and theories of actively practicing physicians 4) diagnostic tales gleaned from medical conferences, personal experience, and journals. With this plethora of information, it is up to the author to craft a story of diagnostic challenges. However, Dr. Sanders is not up to the task and we are left with a sea of facts, little humanity, and a derivative tone that falls severely short of its potential. A bizarre unraveling at the end of the book include a chapter-long rant against chronic Lyme disease and an oddly impersonal tale of her alcoholic sister's death. This type of work has been done before, and it has been done beautifully. Unfortunately, this book does not know which story it is trying to tell, and the reader is left with very little that is memorable or substantive.
13 of 16 people found the following review helpful
3.0 out of 5 stars Oddly unsatisfying July 23 2009
By Marcy L. Thompson - Published on Amazon.com
Format:Hardcover|Vine Customer Review of Free Product
I wish I had liked this book more. I wanted to like the book more. The author writes in an engaging and accessible voice about the practice of medicine. I generally enjoy books along these lines, especially the well-written ones, which this is. The premise of this particular book is appealing: the stories of how doctors diagnose difficult cases.

The subtitle promises that the book is full of medical mysteries, and indeed, the stories in the book about people with strange collections of symptoms whose illnesses proved very hard to figure out are as compelling as I expected.

The problem is that these stories are not quite what the book is about. It's as if the author started to write a book about medical mysteries and then got sidetracked. The digressions are about interesting and important issues (why the physical exam is something of a lost art and what this might mean for the practice of medicine, for example). However, they don't fit into the book as it's designed and as it presents itself. It's as if you went to see what you expected to be a romantic comedy film and found yourself faced with something that started out sort of like "When Harry Met Sally", where the middle portion of the movie was more like "Midnight Express", with a few scenes pulled from "The Sound of Music", and then the ending of Harry and Sally, followed by a fragment from a lecture on Plato.

It's not that all the parts aren't worthy themselves. It's that they by no means make a coherent narrative. Worse, imagine that the director, writer, and actors in the mish-mosh movie insisted that it was simply a romantic comedy. That the detective stories are the best parts of the book makes it worse, in some ways.

I've loved books about being a doctor since I read Intern and The Making of a Surgeon more than 35 years ago. I wanted to love this book, too. I think maybe the worst part of the experiences was that the good bits were so very good.

I wish that this author had written two books, one about the medical mysteries of diagnosis and one about the evolving state of the practice of medicine. I expect that both books would be better than this one, and a good deal more satisfying to read.

All that said, it IS a well-written and interesting book, and far from a total waste of time.
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