When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests is a rather awkward mix of a self-help manual for patients (to speak up more) and a blistering attack on what the authors call “cookbook” medicine, medicine by following predefined pathways without (apparently) thinking too much, or at all, about either the patient or a proper diagnosis.
While the stories are compelling and common sense tells us that listening to patients should help doctors make better diagnoses, not to mention make patients feel heard, it’s a little hard to believe that the pathways method is generally disastrous. It would be good to have a more balanced view. And the idea that patients can and will use the probing questions the authors suggest with their own doctors strikes me as rather preposterous. That being said, interesting book and ideas.
The Cost Disease: Why Computers Get Cheaper and Health Care Doesn’t makes the case that health care is costly because it’s hard to automate, unlike product manufacturing (just like education, as described in Why Does College Costs so Much?) but alas fails to reassure that we will continue to be able to afford expensive services since the author seems unable to lay out how productivity increases can come about in health care, a field where there’s little outright competition and payments are typically made by third parties anyway. And since the US spends massively more than other countries on health care without reaping benefits for longevity or other measures of health, the idea that the cost of services will necessarily increase faster than that of goods, while sensible, seems to open the door to unbounded increases…
Monday Mornings reads like a schmaltzy TV series about emergency rooms, and not the first season, with its more daring storylines and deeper character explorations, but more like season 7 or 8, when all the semi-believeable plots have been exhausted and lifesaving clichés are trotted out amongst unlikely personal tragedies. Still, there are some finely observed characters, the more poignant one for me being the older physician who diagnoses his own brain tumor and transforms his rigid personality and life — and the theatrical drama of the morbidity and mortality reviews is appealing.
The Cost of Hope: A Memoir tries to do two things: tell the story of the author’s courtship and marriage to her first husband and tally the enormous costs of caring for his kidney cancer (although the diagnosis remains uncertain, years after his death). It’s a bit of a strange mix, and it did not work for me, although I very much enjoyed the personal story, of a delightfully eccentric man, a challenging marriage, and family routines that get reinvented over and over. Perhaps the accounting exercise could have been partitioned more artfully , if not jettisoned?
How We Do Harm: A Doctor Breaks Ranks About Being Sick in America is a profoundly depressing book, at least for those of us outside the medical profession.Its author, a physician himself, sets out to expose ignorant physicians, greedy physicians, the abysmal lack of care for the poor, and (perhaps the only comforting part of the book, but comforting only to the twisted-minded) the sad consequences of over-screening the rich. The problem I had with the book was not the problems it uncovered; I rather liked, even admired the fearlessness of the descriptions. Rather, it’s that the solutions proposed seemed quite improbable. How can the average patient select doctors who have kept up on newer techniques? How can the same average patient cogently discuss treatment options with a doctor, especially under the fear and pain of disease? How can we patients, even as a group, uncover bad practices and root them out if physicians themselves are timid in taking action against their potentially dangerous colleagues?This is not a comforting or hopeful book!
One would want to look kindly at a book whose author has endured a serious and pretty much untreatable disease and the author of Memoir of a Debulked Woman: Enduring Ovarian Cancer has written an unflinching account of her body’s miseries, together with keen observations of how the medical system as a whole does not serve patients well. But if you have ever wished that a sick friend would hurry up the minute descriptions of her troubles, you may find your patience quickly exhausted. And each experience triggers multiple reminiscences from the large assortment of literature that the scholar-author has read, which makes for many learned dissertations that are not as enjoyable if one is not familiar with the pieces being cited.
With an ambitious title but disappointing contents, The End of Illness claims to take us through an inspiring journey towards better health, all the way to the very end of life, and it does offer interesting insights. The one I liked the most was the idea that the body is a system rather than an assortment of parts so that we should be leery of solutions that target an isolated part. But I thought that the book, despite the prestigious blurb writers it managed to gather, read more like a long commercial for the author’s companies (which peddle personalized medical profiles) and also included some rather stunning statements, without much data to back them up (as in “everyone above 40 should be taking statins”) while in the same breath attacking the wanton consumption of vitamin D. I’m sure vitamin D supplements are useless for most of us, but why would statins be good for all of us? If evidence-based medicine is a good idea, then sweeping statements must be justified by hard data.
The main thrust of Your Medical Mind is that patients make medical decisions based on their unique set of criteria that include their overall philosophy about treatment (maximalist or minimalist), their personal experience about the issue (creating emotions that seem to overwhelm rational thoughts), and the particular issue at hand (critical or not). The book is useful in reminding us that, for many medical situations, there is no one perfect choice, exhibit A being that many times treatment recommendations differ by country, not to mention from physician to physician, since they, too, are human and are influenced by their philosophy of treatment and their experiences (not to mention, sometimes, their financial interest), so what we need is a better dialog between patients and physicians to discuss facts, pros and cons, and potential biases around the decisions, on both sides. Alas, such honest and time-consuming dialogs may not be possible in a medical structure that rewards procedures rather than discussions.
So I thought the book was interesting but could have been better. In particular, it could have done better distinguishing advice to patients from advice to physicians. And it may not be a book to recommend to someone facing a dire medical decision, who may not need to be reminded that medicine is so much more of an art than a science.