Anda di halaman 1dari 42

Raina Keefer Portfolio Feature Articles News Articles Newsletters Advertisements Promotional/Direct Mail Please request

For more information, please contact: Raina.keefer@gmail.com

July 2010 InPractice Insight Monthly E-Newsletter Article Book Review http://www.arrs.org/Templates/TemplateIP_1col.aspx?id=1496 ARRS Updates and News Practice Quality Improvement: Focusing on Patient-Centered Care Many resources can help you improve quality of patient care, but to learn to really improve your practice, perhaps its best to go straight to the source: the patient. In this review of Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis, youll learn from other physicians how they addressed their communication problems and instituted simple procedures to improve patient satisfaction and their own diagnostic ability. Every physician, regardless of specialty, has a story that begins, I had this one patient who, and details diagnostic feats that rival those seen on the Fox TV show, House M.D. But a simple diagnosis is not typically a tale worthy of telling around the water cooler, and its not why fans tune into popular medical shows on TV. Fans are glued to the screen to watch a physician use extraordinary means to discern an illness, often via instinctive, unscientific methods rather than by using factual data and strict protocols. Lisa Sanders, M.D., a Yale University School of Medicine physician, recognizes this intuitive aspect of medicine and illustrates those thoughts in her first book, Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis. Sanders explores a number of difficult cases shes collected over the years from physician colleagues and through research for her monthly column in The New York Times Magazine, Diagnosis, which was the inspiration for House M.D. In narrative style with little jargon, Sanders uses more than a dozen complex cases to demonstrate different aspects of a diagnosis, the first of which requires the patients story one of the oldest diagnostic techniques. She also offers cautionary tales of medical errors, sometimes the result of an inadequate physical exam. Physicians will sometimes skip a physical exam a key part of the diagnosis and rely instead on diagnostic imaging and the results of lab work to point to the problem. Case in point is a colleague in Sanders hospital who was tired of his general surgery residents skipping physical exams and immediately ordering a CT scan for many patients presenting with abdominal pain. His solution? He created a competition wherein surgical residents would get one point for every patient with suspected appendicitis whom they examined and calculated an Alvarado score for. Patients who had a CT scan before being seen by the resident were disqualified, Sanders explains. In a physical exam, physicians must trust their instincts and training, whereas a diagnostic test produces a piece of paper, which they often have more confidence in. Additionally, Most patients believe that it is usually possible to determine what ails them with some kind of a test an X-ray, for example, or an MRI, writes Sanders. As members of patients diagnostic team, and as physicians inherently interested in puzzles, radiologists will find Sanders book entertaining and informative and uncover a few stories to tell around the water cooler.