৵ New Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis 2018 㤛 Kindle By Lisa Sanders ૧

৵ New Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis 2018 㤛 Kindle By Lisa Sanders ૧ ৵ New Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis 2018 㤛 Kindle By Lisa Sanders ૧ Introduction Every Patients Nightmare Barbara Lessing stared out the window at the snowy field behind the hospital The afternoon sky was dark with yet snow to come She looked at the slender figure in the bed Her daughter, Crystal, barely twenty two years old and healthy her entire life, was nowsomehowdying The young woman had been in the Nassau University Medical Center ICU for two days shed been seen by a dozen doctors and had scores of tests, yet no one seemed to have the slightest idea of just what was killing her It all started at the dentists office Crystal had had a couple of impacted wisdom teeth taken out the month before But even after the teeth were gone, the pain persisted Shed called her mother halfway across the state just about every day to complain Call your dentist, shed urged her daughter And she had Finally The dentist gave her a weeks worth of antibiotics and then another After that her mouth felt betterbut she didnt She was tired Achy For the next week shed felt like she was coming down with something Then the bloody diarrhea started And then the fevers Why didnt you go to the doctor sooner the trim middle aged woman scolded her daughter silently Barbara had gotten a call from a doctor in the emergency room of this suburban hospital the night before Her daughter was ill, he told her Deathly ill She drove to Syracuse, caught the next flight to New York City, and drove to the sprawling academic medical center on Long Island In the ICU, Dr Daniel Wagoner, a resident in his second year of training, ushered her in to see her daughter Crystal was asleep, her dark curly hair a tangled mat on the pillow And she looked very thin But most terrifying of allshe was yellow Highlighter yellow Wagoner could feel his heart racing as he stood looking at this jaundiced wisp of a girl lying motionless on the bed The bright unnatural yellow of her skin was shiny with sweat She had a fever of nearly 103 Her pulse was rapid but barely palpable and she was breathing much faster than normal despite the oxygen piped into her nose She slept most of the time now and when awake she was often confused about where she was and how she had gotten there To a doctor, nothing is terrifying than a patient who is dying before your eyes Death is part of the regular routine of the ICU It can be a welcome relief to the patient, or to his family Even a doctor may accept it for a patient whose life can be prolonged no longer But not for a young girl who was healthy just weeks ago These doctors had done everything they could think of but still there was a feara reasonable fearthat theyd missed some clue that could mean the difference between life and death for this young woman She shouldnt die, but the young resident and all the doctors caring for her knew that she might Crystals thin chart was filled with numbers that testified to how very ill she was Wagoner had been through the chart a dozen times Virtually every test theyd run was abnormal Her white blood cell count was very high, suggesting an infection And her red blood cell count was lowshe had barely half the amount of blood she should have Shed gotten a transfusion in the emergency room and another after she was moved to the ICU, but her blood count never budged Her kidneys werent working Her clotting system wasnt either Her yellow skin was covered in bruises and her urine was stained deep red Sometimes, if you just work hard enough to keep a patient aliveto keep the blood circulating, the lungs oxygenating, the blood pressure high enoughthe body will be able to survive even a vicious illness These are the miracles brought by technological advances Sometimes, but not this time The ICU team gave Crystal bag after bag of blood they did their best to shore up her damaged clotting system she got pressers medications designed to increase blood pressure and fluids to help her kidneys She was on several broad spectrum antibiotics And yet none of that was enough She needed a diagnosis Indeed, she was dying for a diagnosis This book is about the process of making that diagnosis, making any diagnosis So often this crucial linchpin of medicine goes unnoticed and undescribed, yet it is often the most difficult and most important component of what physicians do As pervasive as medicine has become in modern life, this process remains mostly hidden, often misunderstood, and sometimes mistrusted In movies and novels its usually the one liner that separates the fascinating symptoms from the initiation of the life saving therapy On television its the contemporary version of Dr McCoys Star Trek magic diagnostic device his tricorder that sees all, tells all But in real life, the story of making a diagnosis is the most complex and exciting story that doctors tell And these are stories that doctors tell Just as Sherlock Holmes or Nick Charles the hero of the Thin Man mysteries or Gil Grissom CSI delights in explaining the crime to victims and colleagues, doctors take pleasure in recounting the completed story of their complex diagnoses, stories where every strange symptom and unexpected finding, every mystifying twist and nearly overlooked clue, finally fit together just right and the diagnosis is revealed In this book Ill take you into those conversations and onto the front lines where these modern medical mysteries are solvedor sometimes not Just a hundred years ago, journalist and acerbic social critic Ambrose Bierce defined the word diagnosis in his Devils Dictionary as A physicians forecast of disease by taking the patients pulse and purse And that was true for most of human history Until very recently, diagnosis was much art than science But since Ambrose Bierce wielded his rapier pen, there has been a revolution in our ability to identify the cause of symptoms and understand the pathology behind them In the era in which Bierce wrote, Sir William Osler, considered by many to be the father of American medicine, was able to write a comprehensive summary of all the known diseases in his 1,100 page masterwork, The Principles and Practice of Medicine These days each tiny sub branch of medicine could provide as many pages on its super specialized knowledge alone At the birth of medicine, millennia ago, diagnosis the identification of the patients disease and prognosis the understanding of the diseases likely course and outcome were the most effective tools a doctor brought to the patients bedside But beyond that, little could be done to either confirm a diagnosis or alter the course of the disease Because of this impotence in the face of illness, the consequences of an incorrect diagnosis were minimal The true cause of the illness was often buried with the patient In recent history, medicine has developed technologies that have transformed our ability to identify and then treat disease The physical examinvented primarily in the nineteenth centurywas the starting point The indirect evidence provided by touching, listening to, and seeing the body hinted at the disease hidden under the skin Then the X ray, developed at the start of the twentieth century, gave doctors the power to see what they had previously only imagined That first look through the skin, into the inner structures of the living body, laid the groundwork for the computerized axial tomography CT scan in the 1970s and magnetic resonance imaging MRI in the 1990s Blood tests have exploded in number and accuracy, providing doctors with tools to help make a definitive diagnosis in an entire alphabet of diseases from anemias to zoonoses Better diagnosis led to better therapies For centuries, physicians had little than compassion with which to help patients through their illnesses The development of the randomized controlled trial and other statistical tools made it possible to distinguish between therapies that worked and those that had little to offer beyond the bodys own recuperative powers Medicine entered the twenty first century stocked with a pharmacopeia of potent and effective tools to treat a broad range of diseases Much of the research of the past few decades has examined which therapies to use and how to use them Which medication, what dose, for how long Which procedure Whats the benefit These are all questions commonly asked and that can now be regularly and reliably answered Treatment guidelines for many diseases are published, available, and regularly used And despite concerns and lamentations about cookbook medicine, these guidelines, based on a rapidly growing foundation of evidence, have saved lives These forms of evidence based medicine allow patients to benefit from the thoughtful application of whats been shown to be the most effective therapy But effective therapy depends on accurate diagnosis We now have at our disposal a wide range of toolsnew and oldwith which we might now make a timely and accurate diagnosis And as treatment becomes standardized, the most complex and important decision making will take place at the level of the diagnosis Often the diagnosis is straightforward The patients story and exam suggest a likely suspect and the technology of diagnosis rapidly confirms the hunch An elderly man with a fever and a cough has an X ray revealing a raging pneumonia A man in his fifties has chest pain that radiates down his left arm and up to his jaw, and an EKG electrocardiogram or blood test bears out the suspicion that he is having a heart attack A teenage girl on the birth control pill comes in complaining of shortness of breath and a swollen leg, and a CT scan proves the presence of a massive pulmonary embolus This is the bread and butter of medical diagnosiscases where cause and effect tie neatly together and the doctor can almost immediately explain to patient and family whodunit, how, and sometimes even why But then there are the other cases patients with complicated stories or medical histories cases where the symptoms are less suggestive, the physical exam unrevealing, the tests misleading Cases in which the narrative of disease strays off the expected path, where the usual suspects all seem to have alibis, and the diagnosis is elusive For these, the doctor must don her deerstalker cap and unravel the mystery It is in these instances where medicine can rise once again to the level of an art and the doctor detective must pick apart the tangled strands of illness, understand which questions to ask, recognize the subtle physical findings, and identify which tests might lead, finally, to the right diagnosis.Lisa Sanders is a paragon of the modern medical detective storyteller The tales here crackle with suspense But what sets her apart is her Holmes like eye for the cluesand her un Holmes like compassion for those who suffer.Atul Gawande, author of Better A Surgeons Notes on Performance and Complications A Surgeons Notes on an Imperfect Science Dr Lisa Sanders is the most acute observer of health care in America In this compelling book, she opens the black box of diagnosis and lets us look inside.Ian Ayers, author of Super Crunchers Why Thinking by Numbers Is the New Way to Be SmartNot whodunit so much as whatdunit, Lisa Sanderss book brilliantly conveys the sleuthing that lies at the heart of medical diagnosis But this is than a set of suspenseful tales unfolded by a skilled storyteller Amid all the flash and dazzle of the modern doctors high tech armamentarium, Dr Sanders finds that all too often it is the ancient skills, of touch and of attentive listening, that serve the physician, and her patients, best of all Enlightening for patients, essential for practitioners, this book should be read by every doctor Im praying that mine will.Geraldine Brooks, author of March, People of the Book, and Nine Parts of DesireLisa Sanders has written a beautiful, thought provoking book about the sine qua non of medical carediagnosis She tells stories about great diagnostic triumphs and explains both the pitfalls and successes of diagnosis Her patient stories captivate the reader as we try to solve the unfolding mystery Through these stories we understand and remember the importance of accurate diagnosis.Robert Centor, MedRants.com Every Patient Tells a Story is a must read for anyone who has ever been a patient or is a doctor Written by a physician I respect and a writer I love, the book is filled with intriguing diagnostic dilemmas that will draw you in, and with human stories that will linger in your mindand heartlong after you are done.Pauline W Chen, author of Final Exam Every Patient Tells a Story Medical Mysteries and the Every is must read for anyone who has ever been patient or doctor Written by physician I respect writer love, the book filled with intriguing diagnostic dilemmas that will draw you in, human stories linger in your mind heart long after are done Art of Diagnosis was great to It about s point view which different kinds patients bringing mysterious symptoms tells story ncbimh Jan , medical mysteries art diagnosis collection similar Selected cases vary from common diseases such as pernicious anemia oddities cannabinoid hyperemesis, chronic marijuana smokers vomit repeatedly but can relieve hyperemesis taking hot HUGH LAURIE Isabel Audiobook Lisa Sanders In Story, Dr takes us bedside witness process solving these other dilemmas, providing firsthand account expertise intuition lead make right EVERY PATIENT TELLS A STORY Kirkus Reviews one feverish clearly suffering severe infection, yet massive intravenous antibiotics weren t helping noticed toes looked gangrenous Sanders, MD Drawing Back Curtains Review Jun But though not quite what expecting it be, still glad have insight provides into at least United States Aug an internist on faculty Yale University School Medicine, show technical advisor 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    • Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis
    • 4.1
    • 391
    • Format Kindle
    • 304 pages
    • 0767922476
    • Lisa Sanders
    • Anglais
    • 20 November 2017

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