When Doctors Don’t Listen- How to Avoid Misdiagnoses and Unnecessary Tests

When Doctors Don't Listen book coverWhen Doctors Don’t Listen- How to Avoid Misdiagnoses and Unnecessary Tests

Dr. Leana Wen & Dr. Joshua Kosowsky
Thomas Dunne Books, 2013

For as long as we could remember, we’ve always heard a variation of, “Oh, listen to the doctor. The doctor always knows best.” We’ve put so much trust into our doctors that sometimes we ignore what our very own bodies are telling us. When Doctors Don’t Listen introduces a new concept that encourages the patient to take a more proactive role in their own healthcare. In this book, Dr. Leana Wen and Dr. Joshua Kosowsky begin to untangle the root causes of over-testing and misdiagnosis in the medical world.

Dr. Wen and Dr. Kosowsky first expose an outdated practice used frequently in the world of doctors: cookbook medicine. Cookbook medicine works by taking the patient’s “main” symptom and sending them down a long road of clinical procedures to simplify the diagnosis process. Because of cookbook medicine, healthcare costs are inflating, unnecessary tests are wasted, misdiagnoses are more frequent, and, most importantly, real communication between the patient and the doctor becomes more and more obsolete.  Using real patient stories from the ER, Dr. Wen and Dr. Kosowsky illustrate a vivid picture of how cookbook medicine leaves patients confused, scared, and alone in the healthcare process.

So the big question is: what can we do about it? Dr. Wen and Dr. Kosowsky offer the eight pillars to a better diagnosis. The eight pillars include options to make yourself an equal partner in the doctor-patient relationship. From participating in your physical exam to telling your whole story, When Doctors Don’t Listen offers seemingly simple tips that are too often overlooked as patients. Overall, When Doctors Don’t Listen offers invaluable advice on how to be a better patient, by treating yourself as a partner with your doctor rather than a bystander.

Inside Rehab: The Surprising Truth about Addiction Treatment—and How to Get Help That Works

Inside Rehab book coverInside Rehab: The Surprising Truth about Addiction Treatment—and How to Get Help That Works

Anne M. Fletcher
Viking Adult, 2013

What do we know about rehab? When we think about rehab today, we imagine glorified hotels for celebrities who have too much time on their hands. Pop culture has twisted the idea that rehab doesn’t really have anything to do with rehabilitation at all. But what happens when it’s your neighbor, or your spouse, or your child, or your friend, who is struggling with addiction? Where do you go then? Anne M. Fletcher, author of Sober for Good, explores the idea of what rehab really is, what works, and how to find it.

In Inside Rehab, Fletcher visits fifteen different rehabilitation programs—some programs are for the spiraling celebrity and others are for the penniless. Her in-depth research includes shocking conversations with real people struggling with very real addictions. After visiting many different rehabilitation centers, Fletcher comes to debunk common myths about rehab and explores which programs are truly beneficial in the journey towards recovery. Throw away any preconceptions you had about Alcoholics Anonymous or the Twelve-Step Program because Fletcher opens a new chapter in searching for the rehabilitation program that is tailored to you.

Inside Rehab goes beyond discussing the necessity for rehabilitation reform; Inside Rehab is also a collection of both heartbreaking and eye-opening stories from individuals who are chained to their addiction. Fletcher doesn’t pretend like she knows what it’s like to suffer with an addiction; instead, she goes straight to the source. She shares the stories of people who have found themselves in a place of complete desperation, looking for a window of light. As a reader, it is sometimes difficult to relate to and understand someone else’s situation that starkly contrasts our own. However, in Inside Rehab, Fletcher perfectly captures the heartbreaking consequences of addiction and why a push towards better rehabilitation is necessary in America.

Catastrophic Care: How American Health Care Killed My Father- And How We Can Fix It

Catastrophic Care: How American Health Care Killed My Father- And How We Can Fix It

David Goldhill
Random House Inc, 2013

UNFORTUNATE FACT:  Thousands of avoidable deaths occur each year due to medical errors in the US and across the World!

FORTUNATE TRUTH:  When author David Goldhill’s father tragically died due to complications acquired during his hospital stay, David knew that awareness and attention needed to be paid to this horrific, frustrating an all too common problem. In writing this book, Catastrophic Care, he has not only succeeded in bringing this problem to light, but he has sparked a call for a healthcare revolution; it is now time for all of us as patient advocates to take charge of the care that we all deserve. As Family Physicians, we share his passion for reducing medical errors.

Our health care system has drastically changed in the last half century.  Fifty years ago, health care was based on urgency and necessity.  Today, the foundation of health care has become increasingly focused on preventive care and managing chronic conditions.  David takes his readers on this journey, describing not only how we got to this point, but how we must continue to move closer to what healthcare must be for all of us: affordable, personable and high quality care.  One aspect of this book that impressed us is David’s passion for how health care would benefit from patients becoming more informed buyers and/or consumers, investing in their own care, instead of simply trusting the government or various political constituents. He is supportive of regulations that are rational, that are based on quality, that can reduce the costs of care and reduce medical errors.

Millions of us patients and loved family members enter a hospital each year with too little thought to potential medical errors and ways to reduce them.  Catastrophic Care may help us exit the hospital in better condition.  This is not a book just for those interested in policy change; but a book for the everyday patient in all of us.

The Upside of Irrationality: The Unexpected Benefits of Defying Logic at Work and at Home

The Upside of Irrationality: The Unexpected Benefits of Defying Logic at Work and at Home

Dan Ariely, PhD
HarperCollins Publishers, 2010

Have you ever tried to change a bad habit?  Do you smoke even though you know it is harmful to your health, or have a tendency of going against the doctor’s suggestions because you think you know yourself better than they do?  Well, you are not the only one, and you do have something in common with the author, Dr. Dan Ariely, which is the belief that one must always do what is in their own personal best interest, even if it means going against the grain.

Dr. Ariely’s takes us on a revolutionary journey to better understand what persuades us to behave the way we do.  Whether it is in our office chair, at home of the couch, or in the doctor’s office, there is irrationality to our thinking and behavior.  He is able to provide readers an inside, frame by frame look, at his career’s work of experimentation in regard to human behavior. It is through these narrations of events and observing those involved, that he is able to find the reasons for our irrationality. You may wonder how he came to this conclusion, but you will need to read the book to find out.  One thing is for certain, you will be shocked at the revelations you will find.

This book was not written for the purpose of being another self-help piece on a bookstore shelf.  Dr. Ariely’s vision is for his readers to explore themselves and their best interest in a way that is atypical, so the individual can make changes to benefit their health and life.  The goal is not to emphasize your flaws, but to bring to light both positive and negative “quirks” that you possess.  As these behaviors are brought to the surface, you will begin your personal journey to eliminate the bad behavior and build on the good.  Losing weight, quitting smoking, exercising, and better sleep all deserve your thoughts as you read Dr. Ariely’s book.

Doctor, Your Patient Will See You Now

Doctor, Your Patient Will See You Now

Steven D. Kussin, M.D.
Rowman and Littlefield Publishers, Inc, 2011

Has there ever come a time when you had the feeling that your doctor simply had it wrong?  If you answered “yes” to this question, not to worry, you are not alone.  Dr. Steven Kussin has written a book that patients should consider as a “go-to” manual for taking back their health care. Based on his experiences both as a physician and patient, Dr. Kussin offers readers an alternative view; a view from the physician’s side as to what truly happens in medicine and how patients can and should take control over their own health care.  In addition, the author is able to spark interest in the health care system by casting a new light on the way we think and act regarding our own health care.

Accepting unquestioning medical advice from your physician is now, or at least should be according to this book, a thing of the past.  Where physicians once dictated medicine, patients have now become more knowledgeable, questioning and involved in their health care.  Think about it- do you think that when doctors are patients, we sit back and accept what we are told.  Rather, it is our right of all of us to question, to seek out additional information, and determine what the best course of treatment is for ourselves.  We should expect the best and do away with anything less than that.

Throughout this book, Dr. Kussin takes us on a journey of what it is like to be a  person on the other side, a physician trapped in a system of “I think,” “the last time I checked,” “as far as I know,” and even “it’s what I was told.”  His pent-up frustrations on a health care system that too often  causes harm to those he took an oath to protect are reflected through the tips and suggestions he offers readers. It becomes clear that his intention for writing this book is not to destort or destroy society’s view on our health care system, but to create a beneficial change that would hopefully result in a patient-centered health care system where the individual is able to take control of what is rightfully theirs. This book is a good start and an easy though at times painful read.

Power, Politics and Universal Health Care

Power, Politics and Universal Health Care: The Inside Story of a Century-Long Battle

Stuart Altman & David Shactman

Prometheus Books, 2011

It is not every day that a new book comes out from a health economist that has advised five Presidents over 30 years about health care reform efforts in the U.S.  Thus, there is perhaps few in America who have more experience and insights to share about what has occurred over the last century to provide affordable, equitable and high quality care to all Americans.  Dr. Stuart Altman, and his colleague David Shactman, have written what is clearly one of the definitive books on the quest for universal health care for the American public, and as such, the book is a must read for experienced clinicians, patients, consumers, politicians, and students of all persuasions.

Dr. Altman has clearly “been there” to analyze pivotal moments of health care reform in the U.S. Starting with adoption of Medicare in 1965, to Social Security Disability Insurance in 1972, to coverage of End Stage Renal Disease, he has examined, advised and led many efforts to expand health care coverage to at-risk populations.  In the last decade, we have witnessed prescription drug coverage, coverage of children, and finally the Affordable Care Act under President Obama.  Dr. Altman has been there through the good, the bad and the ugly of health care reform.

In this book, Dr. Altman and Mr. Shactman take us into the narrative of not just what has worked and what has failed, but why they have worked and why they have failed.  They tell us about how reform wins or loses based on the national economy, interest group agreement and opposition, and of course political opposition.  The best part of this book is that it reads much like a detective novel, with chapter titles like “Nixon comes close- plan looks like a slam dunk, but end with just a dunk” and “Clinton chooses wrong- the colossal defeat of managed competition.

Through sexual trysts by leading politicians to purposeful gaffs by the American Medical Association, the authors hold little back. In so doing, the let us know why health care reform happens and what it will take to take on the next chapter, regardless of whether or not the Supreme Court rules the Obama plan Constitutional or not.  All the people that the authors describe appear eminently human, and that is what gives the book its special appeal.   The blueprint they offer for future health reform is something to take note: strike early, get Congressional buy-in, don’t deal with expanded costs and access at the same time, use every tool, including public relations, and maintain commitment and determination. In the end, we are left with a better health care system, but one that still spends close to 20% of its GDP on health care. Such costs are not sustainable, and ultimately, we will all have to figure out how to pay the price of what everyone desires, health care as a right for all.

Listen to Dr. Altman and Dr. Shactman talk about their book on Your Health.

Confessions of a Surgeon

Confessions of a Surgeon book coverConfessions of a Surgeon- the good, the bad, and the complicated…Life behind the OR doors

Paul A. Ruggieri, MD
Penguin Group, 2012

Sometimes, the title of a book says it all.  In this case, the title is just an appropriate inducement for all patients who may need or have had surgery to read and even study.  Dr. Ruggieri is a General Surgeon with a wealth of experience in the OR, the kind of surgeon we would normally value as a colleague (General Surgeons and Family Practitioners relate well usually to one another and know what it means to care for people over their lifespan).  While the public knows frequently the grueling lifestyle of a Surgeon, and what it takes in training, perhaps they think of surgery itself in more magical terms.  Dr. Ruggieri aims not to destroy that magic, but he wants patients to know that surgeons are human, that mistakes happen, that empowered families can frequently improve their surgical outcomes for loved ones by being strong advocates and asking tough questions before surgery, and even how to pick a really good surgeon. Dr. Ruggieri does all of this while telling stories from his 20 plus years as a surgeon.  This combination of powerful stories and practical advice is what gives this book its unique charm.

Truly insightful stories involve Dr. Ruggieri talking about the value of saving lives, whether that life is an insured wealthy patient or a criminal that comes in with him on-call.  This devotion reminds us of the noble reasons most physicians chose a career in medicine.  Yet, this is not simply stories, as basic questions critical to ask your surgeon, like “How many times have you performed this particular operation”, “What are the major risks of a particular procedure” and “what is the normal complication rate as well as YOUR complication rate” are addressed.  Your surgeon should be able to address these questions as routine part of pre-surgical care.

Dr. Ruggieri talks about an area that most doctors never do publicly- mistakes he may have made. Rather than make excuses, he take responsibility, and tries to learn, not moving on past the mistakes, but moving forward living and learning with them.  Such admissions are a confession that Dr. Ruggieri offers to patients and other physicians alike, a way to help us focus less on medical malpractice, and more on communication and patient safety.  In today’s medical marketplace, this message alone makes Confessions of a Surgeon worth reading.

Listen to Dr. Ruggieri talk about his book on Your Health

Global Warming & Political Ecology Health

Global Warming & Political Ecology of Health

Hans Baer & Merrill Singer
Left Coast Press, 2009

In the book, Global Warming and the Political Ecology of Health the authors lay out poignantly about the severe economic, social, political and health consequences that global warming will (is) having on all of us.  As medical anthropologists, the authors attempt to move beyond simple explanations about adaptation to a more expansive view of fundamental changes that must occur for the planet to survive.  They argue that world orders must change from primary capitalist systems to global democratic systems.  They describe fundamental problems that even “green capitalism” fails to address in changing catastrophic forces of global warming.

This book examines in no nonsense the multitude of unfolding global problems from global warming.  The authors detail the stages of global warming awareness, from open denial to waiting for undeniable proof, to minimalism, to awakening to the crisis, to panic (when it is too late to effectively intervene). The facts presented are compelling, especially that global CO2 is at its highest level in the last 600,000 years, and eleven of the last 12 years are the warmest on record ever recorded.

The authors do an equally good job of succinctly reviewing the myriad of health and medical effects in Chapters 2-5.  The fears of unknown consequences are real, including potential release of catastrophic levels of methane from the sea floor from rising ocean temperatures, extensive flooding of much of coastal areas worldwide (including the entire Eastern seaboard, severe drought in much of the world, scarcer water supplies, reduction of food stocks and plant/animal diversity, new diseases and more resistant microbes, more environmental catastrophes like earthquakes and tsunamis, and increased regional conflict.

The remainder of the book is a explanation for why the authors believe capitalism cannot solve global warming, but rather a new democratic, ecosocialist solution is required.  The descriptions of the problems with capitalism are less novel than the assessment the authors do to examine ways to fix global consumption.  They argue that reformist strategies- including technological fixes, alternative forms of energy, changes globally in mass transit, new forms of heating and cooling, more efficient buildings and homes, the redesign of cities, restoring degraded environments, protection of biodiversity and less reliance on airplanes- are necessary but not sufficient. Rather, they advocate for nonreformist reform that focuses on global social equality, democracy and environmental sustainability.

Political names aside, some of the proposed solutions seem eminently necessary, such as a 60% reduction in greenhouse emissions within 10 years and a 90% reduction within 20 years, transitioning to a zero wast economy, and seeking 10 star energy efficiency on new buildings.  Other solutions are those of socialist reform, highly unlikely to see the light of day in the U.S. (and evidence seems sparse that the Government could accomplish either), such as putting all power industries and transportation industries under public control and an end to industrial farming.

This book forces the reader to confront the question of critical tipping points in global warming, and to answer what would  “we” do and what should we do. By educating others about these questions, this book makes an important contribution.


Book cover
DREAD- How Fear and Fantasy Have Fueled Epidemics From the Black Death to Avian Flu
Philip Alcabes
Public Affairs Books, 2009

DREAD is a fascinating look at how humans have reacted to epidemics throughout history.  Written at a time when society’s fear of swine flu was at a peak, Philip Alcabes presents a cogent argument that policy-makers, physicians and the public must avoid fear and imagination in dealing with epidemics, and instead focus on facts and action.

It is clear that we use the term “epidemic” loosely today, describing the “obesity” epidemic, or the “epidemic of untreated diabetes”.   While these are serious conditions, the public can lose focus on what the term really conveys- the sudden appearance of disease or forces that catastrophically kill large segments of the population.  Separating out fact from fiction, political agenda from medical certainties, fear from a frontal intervention, is the goal of Alcabes’excellent book.

Alcabes focuses on the physical events of epidemics, the social crisis that develops, and the narrative that follows, tracing this sequence through different public health events.   Americans worried excessively about an “anthrax” epidemic in the early 2000’s after several people died and became sick from opening letters contaminated with anthrax.  Despite public fear, this was no epidemic, and the hysteria eventually died, but at a great public and political cost.

Contrast the fear of anthrax with the great epidemic of history- Plaque.  In the 14th century, plague killed over 25 million people, one in four living in Europe.  The moral narrative about plague imbued it with great social stigma, so much so, that in attempts to eradicate it, pogroms occurred against Jewish European communities, whose members were “blamed” for plague.  Alcabes also traces the AIDS epidemic where gay men were heavily stigmatized as well as the links between cholera epidemics and political structures, such as those affecting Haiti and poverty.

A persistent theme underlying most of these narratives is that if someone is to blame for an epidemic, we will vilify them.  Ultimately, the fear of “catching” a dreaded disease, whether it is tuberculosis, malaria, plague, HIV or cholera, can drive irrational decision making, rather than more straightforward public health approaches.  This blame game obscure an approach of what we can and must do to prevent deaths.  For instance, in Haiti after the recent earthquake, we could have prevented cholera transmission by providing safe sanitation.

Today, Alcabes believes that powerful interests, often times allied with politically profitable enterprises, have skin in the game about what gets defined as an epidemic.  He challenges us to better understand that in a world filled with risks, deciding what is an imminent danger and what is not is critical. A fear of modernity as a cause of disease, from the internet and technology, to fast food or fast cars, should not cause us to panic, and we should not be “sold” future epidemics with the same fear that we approach truly known problems. Instead, we should admit that the major health problems facing society are systems problems, have multiple causes, and reflect usually competing priorities in nature or our social environment.  One of the biggest problems for epidemic transmission today, Alcabes says, is fear and panic itself- thus the name of the book, DREAD.

In the end, Alcabes  wants  us, as physicians and patients, as consumers and policy-makers, to not only confront our anxiety over health in a world where longevity is increasing and where we can intervene quicker and more effectively than ever before in human history, but also deal effectively with the real epidemic diseases that still kill millions around the globe- like malaria, TB and diarrhea.

A minor criticisms of the book is that it fails to realize that today we are beginning to live in a world where chronic diseases kill more people than acute illness- and some of the chronic diseases are completely preventable, like cigarette smoking pushed and peddled by the tobacco industry.  Another shortcoming is that the book blames many outside interests for creating fear, for making a narrative that provokes anxiety.  This however, is not always true- for instance, the epidemic of impending dementia is something anyone fears who has witnessed their loved ones become unrecognizable.

We can all agree that if our goal is to save lives, we need to intervene now on the major causes of disease, with all effective tools at our disposal, whether it is AIDS or other contagion, nicotine addiction or global warming.

For this reminder to act, and not be paralyzed by fear or anxiety, DREAD is a wonderful read.