Free Ebook When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests, by Dr. Leana Wen, Dr. Joshua Kosowsky
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When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests, by Dr. Leana Wen, Dr. Joshua Kosowsky
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In this examination of the doctor-patient relationship, Drs. Wen and Kosowsky argue that diagnosis, once the cornerstone of medicine, is fast becoming a lost art, with grave consequences. Using real-life stories of cookbook-diagnoses-gone-bad, the doctors illustrate how active patient participation can prevent these mistakes. Wen and Kosowsky offer tangible follow-up questions patients can easily incorporate into every doctor’s visit to avoid counterproductive and even potentially harmful tests. In the pursuit for the best medical care available, readers can’t afford to miss out on these inside-tips and more:
- How to deal with a doctor who seems too busy to listen to you
- 8-Pillars to a Better Diagnosis
- How to tell the whole story of your illness
- Learning test risks and evaluating whether they’re worth it
- How to get a working diagnosis at the end of every doctor's visit
By empowering patients to engage with their doctors as partners in their diagnosis, this essential guide enables patients to speak up and take back control of their health care.
- Sales Rank: #465109 in eBooks
- Published on: 2013-01-15
- Released on: 2013-01-15
- Format: Kindle eBook
From Booklist
All doctors are taught the art (and value) of obtaining a thorough medical history from their patients. An estimated 90 percent of diagnoses can be made from the history of illness alone. Increasingly, though, many doctors are paying less attention to these stories of sickness. Algorithms and clinical pathways, time constraints, fear of misdiagnosing a serious illness, and an increased reliance on technology have often relegated conversations between physicians and patients into brief interrogations. Physician-authors Wen and Kosowsky utilize true tales of patients treated in the emergency room to illustrate “how medicine has morphed from thoughtful engagement between doctors and patients to cookie-cutter recipes that regard all individuals alike.” The authors argue that such a cookbook methodology can be hazardous. They recommend “an individualized, patient-centered approach to diagnosis” that enhances patient comprehension, lowers the chance of malpractice lawsuits, and cuts down on the excessive use of tests such as CT scans. Sound suggestions for improving diagnosis abound. For patients, become more active participants in the process. For physicians, take time and listen. --Tony Miksanek
Review
"This is a well-written book on an innovative approach to healthcare reform: it challenges patients to take charge of their health and every medical encounter with their doctor. An important topic and an important book--I encourage my patients to read it."
--Siddhartha Mukherjee, author of The Emperor of All Maladies: A Biography of Cancer
"I have always said that a hospital can kill you as sure as cure you. You must be your own best advocate. Follow the advice of Drs. Wen and Kosowsky...and transform from being a patient to an advocate for your own health."
--Fran Drescher, actor, producer, activist, and author of Cancer Schmancer
"It's critical for patients to advocate for their own health. This book teaches you how...Read it; it will change radically how you approach your doctors."
--Melissa Etheridge, Academy Award- and Grammy Award-winning musician
"This clearly-written, brilliantly and creatively thought-out book, filled with fascinating and horrifying examples of how doctors are now trained to not listen to their patients in order to 'rule out' diseases, focuses on 'ruling in' diagnoses that not only are accurate, but that will save billions of dollars per year in lawsuit-driven tests. A brave, terrific, essential work."
--Samuel Shem, M.D., Ph.D., author of The House of God and The Spirit of the Place
"A powerful appeal for individualized medical evaluation based on an active partnership between doctors and patients...."
--Harvey V. Fineberg, M.D., Ph.D., President, Institute of Medicine
About the Author
Dr. Leana Wen is a physician at Harvard and Brigham & Women's Hospital/Massachusetts General Hospital. Inspired by her own childhood illness and then her mother's long battle with cancer, Dr. Wen is a recognized expert on patient advocacy and patient-centered care. A Rhodes Scholar, she graduated with distinction from the University of Oxford and Washington University School of Medicine. She has served as a consultant to the World Health Organization, Brookings Institution, China Medical Board, and the National Institutes of Health, and is currently the National President of the American Academy of Emergency Medicine/Resident & Student Association.
The 2007 winner of The New York Times journalism contest, Dr. Wen has reported in Africa with journalist Nicholas Kristof, and has written for The Lancet, Journal of American Medical Association, The Washington Post, among others. Dr. Wen is traveling around the U.S. and in Europe, Asia, and Africa to speak about patient empowerment and her first book, When Doctors Don't Listen: How to Prevent Misdiagnoses and Unnecessary Tests.
Dr. Josh Kosowksy is an expert clinician and the clinical director of the Brigham & Women's Emergency Department. He is a former Fulbright Scholar and a graduate of Harvard College and Harvard Medical School. A director of the "Introduction to Clinical Medicine Course" which helps prepare Harvard medical students for their hospital clerkships, he has introduced innovative elements to the curriculum around patient-physician communication. Dr. Kosowksy is the author of dozens of journal articles and textbook chapters, and has given invited presentations to hundreds of hospitals and medical schools around the country. He serves on the Editorial Board of a half-dozen medical journals, ranging from Annals of Emergency Medicine to The American Journal of Cardiology.
Most helpful customer reviews
44 of 44 people found the following review helpful.
A sensible, much-needed book about patient engagement
By KC
This is, first and foremost, a book for patients and the lay public. In the opening chapters, the book uses real patient stories to illustrate the problems of so-called "cookbook medicine" - the idea that patient encounters can be simplified into a single complaint that can be worked up using a defined, inflexible clinical pathway. As a doctor working in an emergency department, I have definitely seen this type of medicine practiced and completely agree with the authors that it contributes to over-testing, robotic diagnosis, escalating health care costs, and patient disempowerment.
In subsequent chapters, the authors provide a comprehensive list of concrete tips to avoid the pitfalls of cookbook medicine, emphasizing that the key is creating a respectful, equal partnership with doctors. The authors argue that all people can optimize their health care interactions by taking a more active role in their care, regardless of the quality or personality of their doctor. One particular strength of the book is that it helps readers learn how to communicate with doctors by discussing medical training, medical lingo, and how doctors make diagnoses. In the same way that it helps to know a little about cars and car mechanics before going to a garage, it helps to know a little about medicine and medical providers before seeking care.
In short, this is a book that I would recommend to anyone looking to become a more effective user of the health care system. While medical providers might find parts of this book a little basic, I would also recommend the book to them because it challenges many aspects of conventional practice and highlights the paramount importance of the medical history. I found myself re-evaluating my patient communication style after reading this book, and I think that many other providers will do the same.
29 of 30 people found the following review helpful.
Informative, but A Bit Too Optimistic -
By Loyd Eskildson
The authors (E.R. physicians and Brigham and Women's hospital in Boston), contend that today's practice of medicine has morphed into a cookbook 'pathways' approach that leads to less accurate diagnoses, worse outcomes for patients, and contributed to ballooning costs. Excessive testing is estimated to contribute 10% to the cost of health care, as well as unneeded worry and sometimes useless/harmful treatment. Their point, however, is not to do away with all attempts to standardize care (eg. Atul Gawande's simple rules to prevent infections in ICUs and ORs are an invaluable contribution), but to modify them as appropriate for the patient.
The authors draw upon their own experiences to present their case. Their first example involved a patient (Mary) with stomach pain, vomiting, and diarrhea. She went to the E.R. - blood work and a CT scan were called for. While waiting for the result she started feeling better, but they told her the CT scan was abnormal and a more specialized scan was needed, 120 miles away in Boston. The second CT told them she was fine - probably just a viral illness. Drs. Wen and Kosowsky contend this would have been avoided if her original caregivers had really listened to how her symptom's started. They add that part of the problem is that it's now become so easy to order eg. a CT; thus, doctors will do so 'because I want to be sure I don't miss anything' and many doctors have stopped thinking about what they're being used for.
Many physicians contend that cutting down on tests risks medical liability suits. In response, the authors believe that the biggest problem, per patients who have sued, is some version of 'the doctor didn't take the time to listen to me,' or 'didn't tell me what all the tests were about.' Further, discussions with malpractice lawyers also support a conclusion that this fear is unfounded.
Another point supporting algorithms is that they are useful in stressful, high-risk situations. They end with some guides on how to obtain a better diagnosis.
Bottom Line: 'When Doctors Don't Listen' is informative, but the authors are too optimistic about patients' ability to effectively counter 'medical experts.' I had a very similar experience to their patient Mary with stomach pain, vomiting, and diarrhea. The E.R. did a CT and discovered something of concern and wanted to admit me, even though I was by then feeling much better. Bowing to expertise, I agreed. Two days later, the entire process became absurd in my mind - feeling fine. Yet, they were still worried about the CT scan, and by then I had been assigned a team of six specialists who, in addition to the admitting E.R. doctor, had veto power over my being discharged. And did they ever drag their feet, each stopping by for about two minutes/day to do a quick listen to my heart (never a concern) and then bill Medicare. I tried calling Social Service for assistance, then talked to the head nurse - she confirmed for me that if I left 'against medical advice' I risked having insurance not pay the bill. So I soldiered on, wasting taxpayer money.
21 of 21 people found the following review helpful.
"A Must Read" Outstanding Book for Everyone. The most sensible purchase that may save your life.
By luisjms
I have worked in the healthcare field for almost 30 years. While I am not a physician I have seen first hand what Dr. Wen and Dr. Kosowsky describe in this most excellent book. These doctors have the guts and the fortitude to tell the real story, one that many physicians would rather not have their unsuspecting patients know.
I have worked in Healthcare Quality Management & Health Care Risk Management and tried to improve the quality, safety, and continuity of care that everyone deserves. It is so unfortunate that the KMS syndrome that you describe in your book not only applies to patients, but anyone who works in the healthcare system and tries to make positive changes is attacked by the same system.
The same patient safety issues that have been identified for years continue daily. They cause preventable medical errors and avoidable patient mortality, and cost billions of dollars. The fault lays not only with medical schools, but also nursing and allied health schools that are educating our future health care team of tomorrow. Students are graduating without the very basics of healthcare such as listening skills, common sense, and treating others the way you would want your family or yourself treated if you were the patient.
In the past ten years, I developed an incurable neuro-degenerative disorder and went from being healthy and hardly ever seeing a physician, to a patient-seeking healthcare. For several years I saw specialist after specialist, trying to have the practitioners listen to me about the symptoms I was experiencing. Because I wasn’t emphatic enough, and often kept my mouth shut, I suffered through countless painful and unnecessary tests and medications that made me sicker than my original symptoms.
I had to stop working in a career that I loved -- trying to make a difference in patient safety and patient outcomes. I had to spend two years finding the right physicians who would listen to my story, and work with me to reach a diagnosis and a treatment plan. Even as a healthcare professional myself, I felt helplessly trapped in the system and ready to give up. If I had trouble navigating the system, even with my experience and medical knowledge, I wonder what a layperson would do in the same situation.
I had read another book published by a physician called Unaccountable and then saw your blog and read your book. It made a major difference in my life.
It is physicians like Dr. Wen and Dr. Kosowsky who truly make a difference. Please ignore the very ignorant comments made by Practioners who should not have chosen Medicine as a profession as they lack empathy, caring, and dedication to the Science and Art of Healthcare to help patients of today and tomorrow.
MJ
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