REVIEW: Diagnosis by Lisa Sanders

In brief: Columns from The New York Times about puzzling presentations in medicine that make a diagnosis difficult.

The good: I guessed some of the conditions!

The not-so-good: I didn’t guess others, proving no one person can know it all.

Why I chose it: Really, really enjoyed the Netflix series.

Year: 2019

Pages: 289

Publisher: Broadway Books (Penguin Random House)

Rating: 9 out of 10

In 2019, shortly after getting an internet connection that could handle Netflix, I discovered a great new show. That show was Diagnosis, which was a reality TV show but not in the way you are likely thinking. Each episode told the story of a person who was unable to get a diagnosis of what was wrong with them. The story and video were then published on The New York Times‘ website with the world offering their thoughts on possible diagnoses. Sometimes, the patient was able to find a diagnosis in the crowd of suggestions. Sometimes not. But it shows that when you put a group of minds together, they can achieve great things.

Diagnosis is a collation on Lisa Sanders’ columns in The New York Times discussing rare, strange and missed diagnoses. It’s a fascinating look into how a diagnosis and differential diagnoses are made based on symptoms, test results and what the patient says. The overarching message is to listen to the patient and what they tell you. Like any good mystery, the evidence is often there and can sometimes be solved. (I did find this interesting given that Lisa was an adviser and inspiration for House M.D. – and we all know and parrot his line, ‘all patients lie’). The book is divided into sections, depending on the patient’s predominant symptom (e.g. fever, stomach pain). Reading each section demonstrates the variety of diseases and diagnoses that can come from a similar symptom. Each case is laid out as if the patient is in the hospital, presenting their symptoms. Their past medical history and previous tests are laid out. Imaging and examination results are mentioned. It’s very well done in that the reader can try to work out the neatly summarised problem. Alternative diagnoses are explored and finally, the patient is diagnosed and treated.

As well as listening to the patient, teamwork and collaboration between doctors and specialties is also a strong theme. No one person knows everything, so discussion with colleagues and contacts is highly important. There’s also the good luck element – if you’ve seen one of these rare cases before, you are much more likely to spot it based on experience. (For example, there is one case of Takotsubo cardiomyopathy. Being fascinated by this syndrome and Japanese, I’ve read a lot about it and seen some cases. This one jumped out at me. But I’ve never been to the Caribbean nor worked in a tropical area, so diseases specific to the tropics don’t stick in my head so well. But I do know some people who are especially knowledgeable).

My only complaint with the book is that everything is wrapped up neatly in a particular word count which is indicative of the newspaper columns they came from! I’d love to see an extended case in print. Overall, the book is explained brilliantly to both the lay person and medical staff and written in a way that respects all involved, from the patient to those who didn’t make the diagnosis. Just try and stop yourself after you promise ‘just one more chapter’.

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