Quotable Quotes from Every Patient Tells A Story

Every Patient Tells A Story is a book written by Dr. Lisa Sanders, one of the medical consultants of the popular television series House MD.

In this book, she talks of interesting cases such as Wilson Disease, Rocky Mountain Spotted Fever, Lemierre Disease, Lyme Disease, Thoracic Outlet Syndrome, Sjögren Syndrome, Still’s Disease, Giant Cell Arteritis, and IPEX Syndrome (Immunodeficiency, Polyendocrinopathy, X-Linked). She even mentioned a case wherein a chief complaint of forgetfulness was due to a paraneoplastic syndrome (due to hormone/s produced by malignant cancer cells).

Consequently, she echoed the paramount importance of history taking and physical examination, asserting that not even the CT Scan could fully replace the Stethoscope.

She also discussed the fact that neither Google nor any other diagnostic software could accurately diagnose the more common diseases. However, Google, being free and accessible is actually the best diagnostic tool for rarer diseases with unusual manifestations. She believes that no software can ever replace the medical doctor.

Here are some notable quotes from the book:

“I’d like to mention—endocarditis, tuberculosis, Wegener’s granulomatosis, Kawasaki’s aortitis, Jakob-Creutzfeldt dementia, and eosinophilic gastritis.” She rushed through this list of arcane diseases and ended with a laugh. “I don’t know any of the cases I’m about to hear but there’s a darn good chance I’ve mentioned at least one case diagnosis in that list.” – Dr. Faith Fitzergald (Every Patient Tells a Story)

“In this forum, even if you don’t ultimately figure out the case, you get credit for having the final diagnosis among the diseases you considered on the way. Fitzgerald was acknowledging that the cases she would be likely to confront that day would not be the same as those doctors routinely see in daily practice. Instead they would be the “fascinomas,” the intriguing cases physicians share at the watercooler, the nurses’ station, or in hospital stairwells.” – Dr. Lisa Sanders (Every Patient Tells a Story)

“Doctors build a story about the patient in order to make a diagnosis. It is a story based on the patient’s story but it is freed of most of the particular details of the individual, and structured to allow the recognizable pattern of the illness to be seen.” – Dr. Lisa Sanders (Every Patient Tells a Story)

“You’re starting out on the journey across this bridge, this education, and right now you are on the same side as your patients. And as you get halfway over the bridge you’ll find yourself changing and the language the patient had and you had is being replaced by this other language, the language of medicine. Their personal story is being replaced by the medical story. And then you find yourself on the other side of that bridge—you’re part of the medical culture. When you get there, I want you to hold on to every bit of your old self, your now self. I want you to remember these patients.” – Dr. Lisa Sanders (Every Patient Tells a Story)

“Medicine—to the extent that it can be called a science—is a sensual science, one in which we collect data about a patient through touch and the other senses according to a systematic method in order to make a diagnosis. Most patients are willing to be touched by their doctor. They expect it.” – Dr. Lisa Sanders (Every Patient Tells a Story)

“In medical school, starting with anatomy class, doctors are taught to understand the body by taking it apart, one piece at a time. What you walk away with, at the minimum, is an uncanny ability to objectify the hell out of even the most intimate body parts. For anyone else, this might be considered disrespectful, but for doctors, a clinical and objective view of, say, a female breast offers us the chance to see it isolated from its other, often sexual, contexts. We are taught to handle a breast as a separate object.” – Dr. Lisa Sanders (Every Patient Tells a Story)

“The sicker the patient, the greater the temptation to skip the fundamentals—like the physical examination—and to rely on the available technology to provide us with answers. It’s a temptation that can sometimes prove fatal” – Dr. Lisa Sanders (Every Patient Tells a Story)

“Those minutes of terror and confusion I felt standing powerless in her room served as a visceral reminder throughout my training (and even now, occasionally) that the big picture isn’t enough in medicine; that the overall impression of a patient is worthless without looking further and paying attention to the specific measurements of health or sickness that were behind the impression in the first place.” – Dr. Lisa Sanders (Every Patient Tells a Story)

“You mustn’t avert your eyes from abnormality. You need to seek it out. You need to figure it out. And it doesn’t just turn off when you leave your office.” – Dr. Lisa Sanders (Every Patient Tells a Story)

“We have tremendous faith in our ability to see what is in front of our eyes. And yet the world provides us with millions of examples that this is not the case. How often have you been unsuccessful in looking for an object and recruited the help of someone who finds it immediately right in front of you? Or had the embarrassing encounter with a friend who confronts you angrily after you “ignored” his wave the night before while scanning for an open seat in a crowded movie theater?” – Dr. Lisa Sanders (Every Patient Tells a Story)

“In many ways, the heart exam stands as a symbol of the entire physical exam. It’s not the most complicated exam—the neurological exam is the probably the most complex. Nor is it the most technically difficult exam—looking at the retina of the eye may get that honor. And it’s not the most time-consuming exam—that would probably be the psychiatric exam. But the heart exam was the first examination developed in modern medicine and the one most strongly linked with the physician’s role as diagnostician and caregiver.” – Dr. Lisa Sanders (Every Patient Tells a Story)

“Testing has changed how medicine is practiced. Doctors can now be far more certain of a given diagnosis with the help of tests than ever before in the long history of medicine.” – Dr. Lisa Sanders (Every Patient Tells a Story)

“Faulty knowledge was the key factor in only a few of the missed diagnoses, each of which involved a rare condition. Faulty data gathering—an inadequate history, missed findings on the physical exam, or misinterpreted test results—was a more common problem, playing a role in 14 percent of the diagnostic errors. Faulty synthesis—difficulty putting the collected data and knowledge all together—by comparison, played a role in well over half of the incorrect or delayed diagnoses.” – Dr. Lisa Sanders (Every Patient Tells a Story)

“Because Google is so universally available, simple, fast, and free, it may become the go-to diagnostic aid for oddball cases. Even the august New England Journal of Medicine finds Google “helpful in diagnosing difficult and rare cases.” Google gives users ready access to more than three billion articles on the Web and is far more frequently used than PubMed for retrieving medical articles.” – Dr. Lisa Sanders (Every Patient Tells a Story)

“Would a kind of super-efficient, integrated, intelligent computer system eliminate all diagnostic challenges? Would it replace doctors? Hardly. I believe the process of diagnosis will be made more effective and that it will be faster and easier in the future to zero in on what’s really wrong with a patient. But there will always be choices to make—between possible diagnoses, between tests to order, and between treatment options. Only a skilled and knowledgeable human can make those kinds of decisions.” – Dr. Lisa Sanders (Every Patient Tells a Story)

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