Title: When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests
Authors: Leana Wen, M.D., and Joshua Kosowsky, M.D.
Publisher: New York: Thomas Dunne Books, St. Martin's Griffin, 2014
Call number: 610.696 WEN -[HEA]
When Doctors Don’t Listen is an unconventional book that encourages you to question the diagnoses of your doctors. The writers, both doctors in the Emergency Room, are concerned about the ‘cookbook approach’ commonly practised by doctors. They describe this approach as relying on rote application, formulas and checklists, rather than devoting attention to the individual’s unique condition. This leads to more medical tests, higher costs and less accurate diagnoses. To avoid becoming a victim of cookbook diagnosis, patients should actively participate in the diagnosis, give full description of their symptoms, question the doctors, and seek clarification on the tests performed.
Illustrated with many real life stories, this book is an enlightening read for those seeking to be better informed about medical care, as well as fans of the medical genre.
Excerpt (Pg 158-159):
“The other day, I had a young man come in with eye pain. His right eye was red and couldn’t stop tearing. My resident had seen this patient first and it seemed like a pretty straightforward case: the young man said he had “conjunctivitis” – an inflammation of the eye – in the past and that this felt the same. The diagnosis seemed to fit. He just wanted something to relieve his symptoms.
“Ah!” I said, “But remember that most of what’s labelled conjunctivitis isn’t actually conjunctivitis!”
The resident wasn’t excited. Neither was the patient. He had already been given a diagnosis –though when the resident and I went in speak with him, he seemed unsatisfied. When I asked him what was the matter, he said, “So why do I always get conjunctivitis?”
“Well,” I replied carefully, “there are a lot of different things that can cause conjunctivitis. Viruses, for example. But usually you’ll have other viral symptoms along with it, like coughing, running nose, sore throat.” He shook his head. “And it’s pretty contagious, so I usually hear about other family members and close contacts having something similar.” No response. “Allergies can cause conjunctivitis,” I continued. “But that tends to be extremely itchy and not so painful.” Nope – it wasn’t itchy in the least, and he’d never had allergies before. We went on to talk about other possibilities – trauma to the eye, prolong contact lens use – nothing really fit.
I was pretty convinced by this point that “conjunctivitis” wasn’t the correct diagnosis at all. “Hmm, perhaps it’s time to expand our thinking. Let me ask you a question,” I offered. “When you’ve had this before, has it always been in one eye?”
He thought of a moment. “Yes, as a matter of fact. And it’s always the right eye.”
“It’s painful, right?”
“Unbelievably. I just don’t like to complain.”
He proceeded to tell me about similar bouts of “conjunctivitis” every few months or so. Every “outbreak” was preceded by intense pain, always on the same side of his head right behind the eye. He’d suffer through a day or two like this and then, magically, everything would be better.
My resident and I looked at each other, and at him. There it was, the diagnosis, staring right straight at us. This man didn’t have conjunctivitis; he had cluster headaches!”
Contributed by Tey Hwee Chen, National Library Board (NLB).