Sherlock Holmes, Dr. House, and My Appendix

Just started reading Dr. Lisa Sanders’ book “Every Patient Tells a Story.” She writes the Diagnosis column for the NY Times, and also is a resource for the TV show House. I hadn’t seen the show, so after reading a few chapters this weekend I also watched a few episodes from season 1.

Sanders references Sherlock Holmes frequently in the book, because so many of these health issues are real mysteries. It’s interesting to think of it that way. And in the TV show, House often says that the patient lies. He doesn’t really mean that they lie, but really it’s that they don’t know the right thing to tell the doctor so that the doctor can find the cure.

It reminded me of when I had to get my appendix removed, about 8 years ago. I was working in my first job and had just had my first business trip, which was exciting but also pretty stressful. I’d also just been diagnosed with Crohn’s a few months before and was sort of getting used to the diagnosis even though I was feeling really good and was basically already in remission. My stomach was hurting really bad for hours, and so finally around 3 am I took a cab to the emergency room. The first thing I told the nurse was that I had Crohn’s disease, and in hindsight it was the worst thing I could have done. It was a busy ER, and even though I had every classic sign for appendicitis, they chalked up my symptoms to a Crohn’s flare and left me sitting there as they ushered everyone else through. Delirious with pain, I ended up calling my GI and begging him to come down to the ER and help me get admitted, which he did, and it was the only reason I was admitted – by then I’d waited 6 hours, and then after multiple tests to confirm appendicitis, I was put in surgery, a full 12 hours later.

It was a mystery, I guess, just how any other diagnosis story begins. However, the ER docs were terrible detectives because they didn’t pay attention to the clues. Yes, I had Crohn’s, but I also had every symptom for appendicitis. If they’d paid attention to that, I may not have suffered as long as I did.

Dr. Sanders’ book shows story after story just like that one. Strange symptoms and doctor’s assumptions send them down the wrong path again and again, sometimes resulting in harm and/or death. It all comes down to poor communication in a lot of ways.

Which is why this is the important thing – communication. Eye contact. The doctor spending time listening, talking, working to really figure out what’s going on. I am hoping that my doctors take a look at this book.

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3 responses »

  1. Sounds like a very interesting book (can I borrow it when you’re done?). I’m a fan of the Diagnosis column and of House. It’s amazing to me that with all of the technology and advances in medicine, so much of a patient’s diagnosis is still based on communication, but it’s true. Good for you for sticking up for yourself!

  2. I always tell anyone who is going to take their car in for work, don’t tell the mechanic what is wrong even if you think you know. Let him tell you what is wrong. You just tell him how it feels, where you think the sound is coming from, what kind of “funny” stuff the car is doing…
    If you are sure of what is wrong and he comes to the conclusion himself that is good. If he comes up with an alternate theory and it sounds good that is good too. If he comes up with a dopey idea you can take it elsewhere.
    I use auto mechanics as an illustration because everyone (mechanics as well as doctors) like to think of themselves as professionals and like to be allowed to do their job. We should let them (with our cooperation, of course)do just that. I don’t have a degree in medicine so all I can do is try to get the smartest person with one of those sheepskins to work on me-or my car.

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