Every Patient Tells a Story (41 page)

173
Comparing the location of Steere’s mystery cases:
Steere AC. David France, scientist at work.
New York Times
, May 4, 1999.

173
In order to transmit the infection:
Steere AC, et al. The emergence of Lyme disease.
J Clin Invest
. 2004;113(8):1093–1101.

173
some studies suggest that the most common presentation:
Tibbles CD, et al. Does this patient have erythema migrans.
JAMA
. 2007;297:2617–2627.

178
Post–Lyme Disease syndrome:
Steere AC, et al. Association of chronic Lyme arthritis with HLA-DR4 and HLA-DR2 alleles.
N Engl J Med
. 1990;323:219–223.

178
They recruited one hundred residents:
Shadick NA, Phillips CB, Logigian EL, Steere AC, Kaplan RF, Berardi VP, et al. The long-term clinical outcomes of Lyme disease. A population-based retrospective cohort study.
Ann Int Med
. 1994;121:560–567.

178
Other studies too have found:
Cairn V, Godwin J. Post-Lyme borreliosis syndrome: a meta-analysis of reported symptoms.
Int J Epi
. 2005;34:1340–1345.

179
Researchers at Tufts Medical Center:
Klempner MS, et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease.
N Engl J Med
. 2001;345:85–92.

179
Two other rigorous trials:
Krupps LB, et al. Study and treatment of post Lyme disease.
Neurology
. 2003;60:1923–1930. Fallon BA. A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy.
Neurology
. 2008;70:992–1003.

181
They don’t trust either physical exams:
The International Lyme and Associated Diseases Society Evidence-based guidelines for the management
of Lyme disease, published November 2006, p. 7,
http://www.ilads.org/guidelines.html
, accessed December 31, 2007.

181
In fact, when used as recommended:
Tugwell P, et al. Laboratory evaluation in the diagnosis of Lyme disease.
Ann Int Med
. 1997;127(12):1109–1123.

181
These are some of the most common symptoms:
Fletcher K. Ten most common health complaints.
Forbes
, July 15, 2003.
http://www.forbes.com/2003/07/15/cx_kf_0715health.html
.

Chapter 9: Sick Thinking

197
Diagnostic errors are the second leading cause:
Bartlett EE. Physicians’ cognitive errors and their liability consequences.
J Healthcare Risk Manage
. 1998(fall):62–69.

197
And a recent study of autopsy findings:
Tai DYH, El-Bilbeisi H, Tewari S, Mascha EJ, Wiedermann HP, Arroliga AC. A study of consecutive autopsies in a medical ICU: a comparison of clinical cause of death and autopsy diagnosis.
Chest
. 2001;119:530–536.

198
One survey showed that over one third of patients:
Berner ES, et al. Overconfidence as a cause of diagnostic error in medicine.
Am J Med
. 2008;121(5A):S2–S23.

200
Faulty synthesis … by comparison, played a role:
Errors of inadequate data collection are probably underrepresented in this sample because it was based on chart review. If something was missed, it won’t be in the chart. To pick up this kind of error requires access to the patient at the time of the diagnosis.

201
“Thinking stops when a diagnosis is made”:
Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them.
Acad Med
. 2003;78(8):1–6.

201
“process of matching”:
Croskerry P. Overconfidence in clinical decision making.
Am J Med
. 2008;121(5A):S24–S29.

201
“the power of thin slicing”:
Gladwell M.
Blink
. NY: Little, Brown, 2005.
http://www.gladwell.com/blink/
.

203
“The trick lies in matching”:
Croskerry P. The theory and practice of clinical decision-making.
Can J Anesth
. 2005;52(6):R1–R8.

206
black men are significantly more likely:
http://www.cdc.gov/cancer/prostate/statistics/race.htm
, accessed May 1, 2008.

207
“despite their ‘objective’ medical training”:
McKinlay JB, Potter DA, Feldman HA. Non-medical influences on medical decision-making.
Soc Sci Med
. 1996;42(5):769–776.

207
And even those factors:
Ibid.

207
One of the many careful experiments:
Arber S, McKinlay J, Adams A, Marceau L, Link C, O’Donnell A. Patient characteristics and inequalities in doctors’ diagnostic and management strategies relating to CHD: a video-simulation experiment.
Soc Sci Med
. 2006;62(1):103–115. 214
In the 1930s:
Gawande A. “The Checklist.”
The New Yorker
, 12/10/07,
http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande
.

214
These basic steps:
Wachter RE.
Understanding Patient Safety
. New York: McGraw-Hill Medical, 2008, p. 23.

215
surgical safety checklist:
Haynes AB et al. A surgical safety checklist to reduce morbidity and mortality in a global population.
N Engl J Med
. 2009; 360, pp. 491–499.

215
checklist before certain procedures in the ICU:
Pronovost Petal. An intervention to decrease catheter-related bloodstream infections in the ICU.
N Engl J Med
. 2006;355, pp. 2725–2732.

Chapter 10: Digital Diagnosis

216
In a 1976 article, a group of doctors:
Pauker SG, Gorry GA, Kassirer J P, Schwartz WB. Towards the simulation of clinical cognition taking a present illness by computer.
Am J Med
. 1976;60:981–996.

221
In 1994 she and a group of thirteen other physicians:
Berner ES, Webster GD, Shugerman AA, et al. Performance of four computer-based diagnostic systems.
N Engl J Med
. 1994;330:1792–1796.

229
In order to measure how well the program can perform:
Leonhardt D. Why doctors so often get it wrong.
New York Times
, February 22, 2006.

229
Mark Graber and a colleague:
Graber MI, Matthew A. Performance of a web-based clinical diagnosis support system for internists.
J Gen Int Med
. 2008;23(supp 1):37–40.

231
According to a 2005 survey done by the Pew Center:
Boone S. Computer users can catch the health bug on line.
McClatchy-Tribune Regional News–The Walton Sun
, November 17, 2007.

234
Finally, the visiting professor asked the fellow:
Greenwald R…. And a diagnostic test was performed.
N Engl J Med
(letter). 2005;353:2089–2090.

235
This story and their own experiences with patients:
Tang H, Hwee Kwoon Ng J. Googling for a diagnosis—use of Google as a diagnostic aid: Internet based study.
BMJ
. 2006;333;1143–1145.

236
Even the august
New England Journal of Medicine
:
Fan E et al. A gut feeling.
N Eng J Med
. 2008;359:75–80.

Afterword: The Final Diagnosis

241
Medicine’s first toehold:
Much of this comes from Roy Porter’s wonderful history of medicine,
The Greatest Benefit to Mankind
. NY: Norton, 1999; as well as from Jacalyn Duffin’s biography of René Laennee,
To See with a Better Eye
. Princeton, NJ: Princeton University Press, 1998.

232
These days, patients who die in a hospital:
David Dobb wrote a terrific piece about autopsy, “Buried Answers,” for the
New York Times Magazine
, April 24, 2005.

243
Small residency programs objected to the ever growing cost:
From Accreditation Council for Graduate Medical Education, a private nonprofit council that evaluates and accredits medical residency programs in the United States, personal communication.

243
Certainly a doctor’s ability to make an accurate diagnosis:
A report from the Agency for Healthcare Research and Quality, written by Washington AE and McDonald KM, The autopsy as an outcome and performance measure (Evidence Report/Technology Assessment 58, October 2002), provided much of the information on the modern history of the autopsy.

Copyright © 2009 by Lisa Sanders

All rights reserved.

Published in the United States by Broadway Books, an imprint of the Crown Publishing

Group, a division of Random House, Inc., New York.
www.broadwaybooks.com

BROADWAY BOOKS and its logo, a letter B bisected on the diagonal, are trademarks of Random House, Inc.

Some of the material in this book appeared in different form in the
New York Times
.

Library of Congress Cataloging-in-Publication Data
Sanders, Lisa, 1956–  .
Every patient tells a story: medical mysteries and the art of diagnosis / Lisa Sanders.—1st ed.
  p.      cm.
1. Diagnosis—Popular works. I. Title.
RC71.S186 2009
616.07′5—dc22

                                                                                    2008041478

eISBN: 978-0-7679-3141-0

v3.0