I enthusiastically agree with blogger/writer, Deborah Kotz in her recent review of Drs. Leanna Wen and Joshua Kosowsky’s patient empowering book, When Doctors Don’t Listen How To Avoid Misdiagnosis and Unnecessary Tests. Kotz writes, ” I always admire doctors who can write books criticizing their own profession, including any shortcomings they may have as practitioners – in an effort to improve patient care.”
The author physicians recognize that narratives are a vital part of medicine. After all, stories about patients, the experience of caring for them and the hopeful recovery from an illness is always a shared story linking the doctor, the patient and family. I know this from my own heart journey following a difficult and perilous triple bypass a few years ago. For sure, the medical narrative is rapidly changing from the doctor’s story to the patient’s narrative.
Wen and Kosowsky restore our faith in good and effective medicine that can and should be practiced. In so many ways I champion them for their important contribution to the rehumanization of medicine in the same way as patient narratives.
In increasing numbers, the new crop of medical students and youthful white coat practitioners recognize that narrative medicine continues to emerge in response to a arteriosclerotic health care system that places bureaucratic budgetary concerns over the needs of the patient. These two author doctors in their timely book offer understanding that there’s a river of confluent sources spilling over the former dam of evidence-based medicine to a new novel narratology practiced among doctors and patients. A recent Wall Street Journal article reinforces this claim.
” The art of medicine, by contrast, relies on spending time with patients to take an accurate medical history, listening to all their symptoms and concerns and using common sense. During medical training, that art can get lost in the demands of mastering the science.”
Several weeks ago at an American Medical Student Association Humanities Institute I was rewarded by the conversations and stories produced by medical students in a workshop I conducted on the writing of illness narratives.
I want to credit blogger Deborah Kotz, who concisely and cogently offers this summary of the book’s recommendations for patients the next time we are in the doctor’s office or even emergency room. Here’s what the authors recommend.
1. Tell a good story. Start at the beginning and proceed chronologically highlighting the most important parts in five minutes or less if possible. Don’t use medical jargon that you may have heard on a TV show like Gray’s Anatomy. Doctors have specific definitions for terms like “radiating” or “palpitations” that may differ from what you’re actually experiencing. If your doctor tries to interrupt your tale with questions, take a breath and ask to continue before the questioning.
2. Always provide context. What was happening in your life when the symptoms started? If they’ve recently gotten worse, explain what you think may have exacerbated them. This will help your doctor to think beyond the set diagnostic protocol and see you more as an individual.
3. Describe symptoms as specifically as possible during a physical exam. If you feel the pain in only one spot, make that known. Also, let your doctor know whether it’s sharp or dull, intermittent or constant. Pain scores that doctors traditionally use — 1 to 10 with 1 being mild and 10 being akin to the worst torture — can often be misleading since a patient’s definition of a 10 maybe very different from a doctor’s.
4. Get a differential diagnosis. Doctors should have more than one diagnosis in mind initially to make sure that all bases are covered. Usually, a doctor will strongly suspect one particular condition while considering a few others. For example, you might be told you likely have a migraine but that if the pain doesn’t abate at all over the next week, you might need a brain imaging scan to rule out a tumor. “Be wary if your doctor seems to focus on one particular disease to rule out,” write Wen and Kosowsky.
5. Ask for the reasons behind every medical test. Your doctor should be able to explain what the test is looking for, how likely you are to have that diagnosis, and whether your treatment plan will change based on that diagnosis. Every test, even a simple blood draw, has risks, according to Wen, so they should all be done for a reason.