Wednesday, January 28, 2015

Books on the Art of Diagnosis

Doctors rely on a variety of academic disciplines to practice the art of medicine. Yes, they draw a great deal on the hard sciences.

However, they also use a measure of psychology, sociology, philosophy and rhetoric in order to take patient histories and persuade patients to follow specific treatment regimes.

They also use interpretive skills when diagnosing. This aspect of medicine interests me a great deal. I've wanted to understand the art of interpreting medical data, and I've found a couple of books that help me with this task.

Jerome Groopman, M.D. published How Doctors Think in 2007. Groopman, an oncologist, draws on his experience as both a doctor and a patient and also shares several anecdotes provided by other doctors.

The book, however, is not just a recitation of case studies. It's an investigation of the scaffolding (or heuristics) that doctors use to make sense of symptoms and test results in order to establish a diagnosis and to monitor treatment. He also presents results of research on how doctors interpret reports and how factors such as their experience or the context of the lab results affects the results--such as false positives and false negatives.

His book persuaded me of the importance of seeking a second opinion, if not a third!

More recently I read Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis by Lisa Sanders, M.D.

This was published in 2009 when the television show House M.D.  (2004-2012) was still airing new episodes.  Sanders worked as one of the technical advisers for the show.  Like House, the book relays a number of difficult-to-diagnose cases.

Again, what's interesting to me isn't the medical cases, but the critical thinking that doctors do.  I may never contract Rocky Mounted Spotted fever, but I am going to encounter the critical thinking skills that doctors perform to diagnose ailments that my family members and I experience.

Fortunately, the majority of Sanders' book is dedicated to explaining the way doctors perceive and interpret symptoms, lab results, and treatment outcomes. Like Groopman, she discusses the scaffolding or frameworks that doctors use.

She makes the observation that many tricky diagnoses are accomplished by new doctors or experienced doctors. It's the mid-career doctors who too quickly make snap judgments and miss a tricky diagnosis.
"So the novice has no expectations, the expert has many expectations. Both states facilitate close observation. Where does that leave doctors (like me) in the middle--after our neophyte days but while still on the road to expertise?" (p. 107)
Now I'm watching House for the first time (well, binge watching, I must confess).  I understand that the narrative demands of a television drama distort the medical truths, but it's still interesting to watch the team argue about how to interpret symptoms, test results and treatment outcomes.

I am not sure of the person's credentials, but I did find a blogger claiming to have medical expertise who analyzes and grades the House episodes for accuracy.

While it may be more fun to analyze the medical professionals on a television show, I believe it's important for me to understand that medical care relies on interpretation.  I am grateful that Groopman and Sanders give the layman some insights into the art of diagnosis.


Books on Aging


  1. One thing I learned from my pediatrician father is that medicine is as much art as it is science, especially when your patients can't talk. I love Groopman.

  2. I agree with Carol's comment. Half the time they guess. I refuse to google medical stuff anymore either. I loved House...what a great show. Too bad it's off the air :(

  3. I have learned the hard way how important it is to get a second and even third opinion before making any decisions about treatment.