A doctor’s insightful reflections on the disconnect between how physicians should practice and how they actually practice.
Although she is a consulting producer for the TV show House, Sanders (Medicine/Yale Univ. School of Medicine) admits that movie and TV doctors make diagnoses seemingly by magic or by uncovering a single overlooked clue. Real doctors listen carefully to patients and examine them, a procedure ignored in fiction but also by many of the current generation of doctors who often prefer tests and advanced technology. “Ultimately,” she writes, “the primary work of doctors is to treat pain and relieve suffering.” Sanders tells the story of one patient who was feverish and clearly suffering from a severe infection, yet massive intravenous antibiotics weren’t helping. A doctor noticed that one of the patient’s toes looked gangrenous. When it was amputated, the infection vanished. Patients and doctors yearn intensely for a diagnosis—so intensely, in fact, that they may find one that doesn’t actually exist. Writes Sanders: “Translating the big, various, complicated, contradictory story of the human being who is sick, into the spare, stripped down, skeletal language of the patient in the bed, and then making that narrative reveal its conclusion—that is the essence of diagnosis.” The author also delves into Lyme disease, a tick-born infection that certainly exists but has given rise to a controversial movement in which a small group of patients suffering fatigue, pains, fever and general misery see a small group of doctors who diagnose a chronic Lyme infection that may require a lifetime of treatment. Studies cast doubt on the existence of this ailment, but both patients and doctors dismiss them, as they dismissed past skepticism of diseases such as the Epstein-Barr virus.
Fans of Jerome Groopman and Atul Gawande will appreciate this first collection by another astute observer of the medical profession.