Nursing Book Club

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

Written by the technical advisor for the TV show House M.D.

By Lisa Sanders, M.D. (Broadway Books, 2009)
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Reviewed By Christine Contillo, RN, BSN

Lisa Sanders, M.D., is the author of  Every Patient Tells a Story. She is also the “diagnosis” columnist for the New York Times, briefing readers monthly about patients with unusual collections of symptoms and how their physicians pinpoint and ultimately treat their problems. It’s almost no surprise to find out that she’s also the technical advisor for the television show House, M.D.

Dr. Sanders came late to her career in medicine. Beginning as a journalist specializing in medical news, she became fascinated by the process of teasing out exactly what is critical to putting a name to the disease. She decided to jump in with both feet and began medical school followed by practice as an internist on the faculty of the Yale University School of Medicine.

In this book, as in her newspaper column, she uses examples of strange and unexplainable illness to illustrate how doctors think, and what information is important to the diagnosis process. Sometimes what is seen or reported is as important as what is lacking. Patients make multiple visits to the ER for chest pain, limb numbness, unusual rashes or strange bruises leaving doctors puzzled. She uses these stories to show just how difficult it is to be a good diagnostician and why assessment skills are still crucial to the process.

Sometimes patients are poor historians, or no one listens to them. Physicians pigeonhole the problem and then discard additional important information when it doesn’t fit. They refuse to use diagnostic software, even when it’s available. Sanders feels that young doctors may no longer learn how to do a good physical assessment, instead relying on “evidence-based” costly and time consuming tests. It’s a wonder that anyone gets better!

As a nurse who watches House for the pure joy of trying to guess which tests he’ll order and how long it will take to solve the medical puzzle, Sanders cracks open the door to how physicians think. Who knew that they sometimes use Google, just like the rest of us?

 Every Patient Tells a Story is written by a journalist who has done her homework. There are statistics that you can drop into conversations when asked about the state of American healthcare, and it’s virtually a self-help book on how you can work with your doctor to help him find the right information at each visit.

Not just a collection of disease detective stories, it’s a cohesive look at diagnosis as an art form. I always tell anyone who asks, when you are sick you need a good diagnostician to figure out what’s wrong, then you need a good nurse to help you get better. She backs me up.  

Christine Contillo, RN, BSN is a public health nurse who suggests joining a book club as a reason to put down trashy magazines and look smart on the subway.

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