Review
Every Patient Tells a Story by Lisa Sanders
They cannot hear a patients story, touch a patients skin, or look into a patients eyes. Sometimes the tests and diagnostic tools are to blame; indeed, relying too heavily on test or lab results can produce a false sense of security in both patient and doctor. Besides her own inborn capacity for problem-solving, Sanders experience as internist, writer, and consultant to House serves her well here, for absorbing anecdotes generously pepper the exposition. --Donna Chavez. For all the data they collect, machines lack important components for diagnosis. Housegood at puzzles; they employ a large variety of skill sets, including the long-lost art of the thorough physical exam, to solve the mysteries of illness. Some errors result in prolonged or ineffective treatment, while others lead to fatal outcomes. Sanders uses this case to explain how computers can help in diagnoses (Google is not bad, she says, but better programs exist). 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. Unlike Berton Rouech in his books of medical puzzles, Sanders not only collects difficult cases, she reflects on what each means for both patient and struggling physician. They occur, she says, despite the huge technological advances of recent years. An abdominal exam would have detected the patient's obstructed, grossly swollen bladder. A man arrives at the hospital, delirious, his kidneys failing. In her first book, internist and New York Times columnist Sanders discusses how doctors deal with diagnostic dilemmas. Batteries of tests are unrevealing, but he quickly recovers after a resident extracts two quarts of urine. 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. g All rights reserved.New York Times columnist Sanders says that misdiagnoses account for perhaps as much as 17 percent of medical errors.