Skip to main content

Diagnosis – Lisa Sanders ****

In the class system of popular science books, Diagnosis has all the marks of good breeding. It is authored by an experienced medical professional, is based on a popular New York Times column, is backed by a hugely successful TV series (House, M. D.), and bears a cover endorsement from a household name in the UK and US (Hugh Laurie). With such a background, what could possibly go wrong? The answer, not surprisingly, is “not much.” Lisa Sanders — the technical adviser to House – gives a frank and engaging tour of the modern diagnostic process, packed with real-life case studies.
The brevity and variety of the case studies means it is hard to get bored with this book; even if one loses track of the argument, there is always another medical mystery to latch on to. Some of these mysteries are bizarre, from the patient who has turned highlighter yellow to the computer programmer who suddenly loses his memory. Others are less colourful but no less difficult or telling: the patient with a tell-tale rash that has been overlooked among his more dramatic symptoms; the enlarged prostate gland, incapacitating an old man’s kidneys, that is discovered by chance in the rush to get him to surgery. All cases are chosen to make a point about medical diagnoses.
Saunder’s main points are: doctors should listen to everything the patient tells them, not just the bare facts; doctors should translate medical diagnoses into a language patients can understand; high-tech testing procedures are no substitute for a sensitive physical exam using at least three of the doctor’s five senses; an uncertain diagnosis is better than a false one; and doctors are not immune to cognitive errors.
In and around these key ideas, Sanders weaves a narrative about modern medical education, drawing from research studies and her own experience. In this regard it is especially interesting to read about the informality of the learning process, with interns thrust unsupervised into physical exams, medical lore passed from doctor to doctor in the corridors, and senior doctors drawing regularly on more experienced staff for help on tough cases. Sanders brings to life the awkwardness of her first physical exam, conducted on a topless patient-trainer; the embarrassment of making basic errors in a field where mishaps can be fatal; the eeriness of her first autopsy and various other medical rites of passage. Another recurring theme is the reasoning process that is involved in making a diagnosis. In this respect, a highlight is Sander’s fond portrayal of a “stump the professor” meeting in which student medics challenge a guest professor with a difficult case, the point being less to get the right answer than to learn from the professor’s approach to the problem. There is also a too-brief section on the cognitive science of medical decision-making, where Sanders does little more than distinguish between intuitive and analytical thought processes.
Occasionally the broader argument of the book gets lost in the details of the case studies. Or rather, it is not clear what the overall argument is meant to be. Over half of the book is devoted to aspects of the physical exam – seeing, hearing, and touching the patient to make a diagnosis – and Sanders clearly wishes to argue for a reversal of the trend towards hands-off medical training and practice. But if that is her argument it is not stated in the introduction or in the non-existent conclusion. And other parts of the book, though interesting in themselves, do not obviously fit into the back-to-basics theme. These include sections on attempts to automate diagnosis with computers, the use of Google as a diagnostic tool, and the curious and unsettling case of the phantom illness “chronic Lyme disease.” This ambiguity of aim is not helped by the book’s odd structure: it is divided into three parts of wildly different lengths.
Diagnosis could have been more carefully planned, but it holds the reader’s attention all the way through and gives colour to some pressing issues in modern medicine.
Paperback:  
Also on Kindle:  
Review by Michael Bycroft

Comments

Popular posts from this blog

The Dialogues - Clifford Johnson ***

The authors of science books are always trying to find new ways to get the message across to their audiences. In Dialogues, Clifford Johnson combines a very modern technique - the graphic novel or comic strip - with an approach that goes back to Ancient Greece - using a dialogue to add life to what might seem a dry message.

We have seen the comic strip approach trying to put across quite detailed science before in Mysteries of the Quantum Universe. As with that book, Dialogues manages to cover a fair amount of actual physics, but I still feel that the medium just wastes vast acres of page to say very little at all. This is brought home here because quite a lot of the sections of Dialogues start with several pages with no text on at all, just setting up the scenario.

As for using a discussion between two people to put a message across, Johnson makes the point that, for instance, Galileo's very readable masterpiece Two New Sciences is in the form of a dialogue (more accurately a discu…

Liam Drew - Four Way Interview

Liam Drew is a writer and former neurobiologist. he has a PhD in sensory biology from University College, London and spent 12 years researching schizophrenia, pain and the birth of new neurons in the adult mammalian brain. His writing has appeared in Nature, New Scientist, Slate and the Guardian. He lives in Kent with his wife and two daughters. His new book is I, Mammal.

Why science?

As hackneyed as it is to say, I think I owe my fascination with science to a great teacher – in my case, Ian West, my A-level biology teacher.  Before sixth form, I had a real passion for the elegance and logic of maths, from which a basic competence at science at school arose.  But I feel like I mainly enjoyed school science in the way a schoolkid enjoys being good at stuff, rather than it being a passion.

Ian was a revelation to me.  He was a stern and divisive character, but I loved the way he taught.  He began every lesson by providing us with a series of observations and fact, then, gradually, between …

A Galaxy of Her Own - Libby Jackson ****

This is an interesting book, even if it probably tries to be too many things to too many people. I wondered from the cover design whether it was a children's book, but the publisher's website (and the back of the book) resolutely refuse to categorise it as such. The back copy doesn't help by saying that it will 'inspire trailblazers and pioneers of all ages.' As I belong to the set 'all ages' I thought I'd give it a go.

Inside are featured the 'stories of fifty inspirational women who have been fundamental to the story of humans in space.' So, in some ways, A Galaxy of Her Own presents the other side of the coin to Angela Saini's excellent Inferior. But, inevitably, given the format, it can hardly provide the same level of discourse.

Despite that 'all ages' comment and the lack of children's book labelling we get a bit of a hint when we get to a bookplate page in the form of a Galaxy Pioneers security pass (with the rather worrying…