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July 2010 InP ractice Insight

Monthly E-Newsletter Article Book Review

http://www.arrs.org/Templates/TemplateIP_1col.aspx?id=1496

ARRS Updates and News

Practice Quality I mprovement: Focusing on P atient-Centered Care

Many resources can help you improve quality of patient care, but to learn to really improve yo

perhaps its best to go straight to the source: the patient. In this review ofEvery Patient Tells

Medical Mysteries and the Art of Diagnosis, youll learn from other physicians how they addre

communication problems and instituted simple procedures to improve patient satisfaction and

diagnostic ability.

Every physician, regardless of specialty, has a story that begins, I had this one patient who

diagnostic feats that rival those seen on the Fox TV show, House M.D. But a simple diagnos

typically a tale worthy of telling around the water cooler, and its not why fans tune into popu

shows on TV. Fans are glued to the screen to watch a physician use extraordinary means to d

illness, often via instinctive, unscientific methods rather than by using factual data and strict

Lisa Sanders, M.D., a Yale University School of Medicine physician, recognizes this intuitive as

medicine and illustrates those thoughts in her first book, Every Patient Tells a Story: Medical the Art of Diagnosis. Sanders explores a number of difficult cases shes collected over the yea

physician colleagues and through research for her monthly column in The New York Times Ma

Diagnosis, which was the inspiration for House M.D.

In narrative style with little jargon, Sanders uses more than a dozen complex cases to demon

aspects of a diagnosis, the first of which requires the patients story one of the oldest diagn

techniques. She also offers cautionary tales of medical errors, sometimes the result of an inad

physical exam. Physicians will sometimes skip a physical exam a key part of the diagnosis

instead on diagnostic imaging and the results of lab work to point to the problem. Case in poicolleague in Sanders hospital who was tired of his general surgery residents skipping physica

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 eve

suspected appendicitis whom they examined and calculated an Alvarado score for. Patients w

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 te

piece of paper, which they often have more confidence in. Additionally, Most patients believeusually possible to determine what ails them with some kind of a test an X-ray, for exampl

writes Sanders.

As members of patients diagnostic team, and as physicians inherently interested in puzzles, r

find Sanders book entertaining and informative and uncover a few stories to tell around th
http://www.arrs.org/Templates/TemplateIP_1col.aspx?id=1496http://www.arrs.org/Templates/TemplateIP_1col.aspx?id=1496http://www.arrs.org/Templates/TemplateIP_1col.aspx?id=1496


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