Skip to main content

Diagnosis – Lisa Sanders ****

In the class system of popular science books, Diagnosis has all the marks of good breeding. It is authored by an experienced medical professional, is based on a popular New York Times column, is backed by a hugely successful TV series (House, M. D.), and bears a cover endorsement from a household name in the UK and US (Hugh Laurie). With such a background, what could possibly go wrong? The answer, not surprisingly, is “not much.” Lisa Sanders — the technical adviser to House – gives a frank and engaging tour of the modern diagnostic process, packed with real-life case studies.
The brevity and variety of the case studies means it is hard to get bored with this book; even if one loses track of the argument, there is always another medical mystery to latch on to. Some of these mysteries are bizarre, from the patient who has turned highlighter yellow to the computer programmer who suddenly loses his memory. Others are less colourful but no less difficult or telling: the patient with a tell-tale rash that has been overlooked among his more dramatic symptoms; the enlarged prostate gland, incapacitating an old man’s kidneys, that is discovered by chance in the rush to get him to surgery. All cases are chosen to make a point about medical diagnoses.
Saunder’s main points are: doctors should listen to everything the patient tells them, not just the bare facts; doctors should translate medical diagnoses into a language patients can understand; high-tech testing procedures are no substitute for a sensitive physical exam using at least three of the doctor’s five senses; an uncertain diagnosis is better than a false one; and doctors are not immune to cognitive errors.
In and around these key ideas, Sanders weaves a narrative about modern medical education, drawing from research studies and her own experience. In this regard it is especially interesting to read about the informality of the learning process, with interns thrust unsupervised into physical exams, medical lore passed from doctor to doctor in the corridors, and senior doctors drawing regularly on more experienced staff for help on tough cases. Sanders brings to life the awkwardness of her first physical exam, conducted on a topless patient-trainer; the embarrassment of making basic errors in a field where mishaps can be fatal; the eeriness of her first autopsy and various other medical rites of passage. Another recurring theme is the reasoning process that is involved in making a diagnosis. In this respect, a highlight is Sander’s fond portrayal of a “stump the professor” meeting in which student medics challenge a guest professor with a difficult case, the point being less to get the right answer than to learn from the professor’s approach to the problem. There is also a too-brief section on the cognitive science of medical decision-making, where Sanders does little more than distinguish between intuitive and analytical thought processes.
Occasionally the broader argument of the book gets lost in the details of the case studies. Or rather, it is not clear what the overall argument is meant to be. Over half of the book is devoted to aspects of the physical exam – seeing, hearing, and touching the patient to make a diagnosis – and Sanders clearly wishes to argue for a reversal of the trend towards hands-off medical training and practice. But if that is her argument it is not stated in the introduction or in the non-existent conclusion. And other parts of the book, though interesting in themselves, do not obviously fit into the back-to-basics theme. These include sections on attempts to automate diagnosis with computers, the use of Google as a diagnostic tool, and the curious and unsettling case of the phantom illness “chronic Lyme disease.” This ambiguity of aim is not helped by the book’s odd structure: it is divided into three parts of wildly different lengths.
Diagnosis could have been more carefully planned, but it holds the reader’s attention all the way through and gives colour to some pressing issues in modern medicine.
Also on Kindle:  
Review by Michael Bycroft


Popular posts from this blog

Cosmology for the Curious - Delia Perlov and Alex Vilenkin ***

In the recently published The Little Book of Black Holes we saw what I thought was pretty much impossible - a good, next level, general audience science title, spanning the gap between a typical popular science book and an introductory textbook, but very much in the style of popular science. Cosmology for the Curious does something similar, but coming from the other direction. This is an introductory textbook, intended for first year physics students, with familiar textbook features like questions to answer at the end of each chapter. Yet by incorporating some history and context, plus taking a more relaxed style in the writing, it's certainly more approachable than a typical textbook.

The first main section, The Big Bang and the Observable Universe not only covers basic big bang cosmology but fills in the basics of special and general relativity, Hubble's law, dark matter, dark energy and more. We then move onto the more speculative (this is cosmology, after all) aspects, brin…

Astrophysics for People in a Hurry – Neil deGrasse Tyson *****

When I reviewed James Binney’s Astrophysics: A Very Short Introduction earlier this year, I observed that the very word ‘astrophysics’ in a book’s title is liable to deter many readers from buying it. As a former astrophysicist myself, I’ve never really understood why it’s considered such a scary word, but that’s the way it is. So I was pleasantly surprised to learn, from Wikipedia, that this new book by Neil deGrasse Tyson ‘topped The New York Times non-fiction bestseller list for four weeks in the middle of 2017’.

Like James Binney, Tyson is a professional astrophysicist with a string of research papers to his name – but he’s also one of America’s top science popularisers, and that’s the hat he’s wearing in this book. While Binney addresses an already-physics-literate audience, Tyson sets his sights on a much wider readership. It’s actually very brave – and honest – of him to give physics such prominent billing; the book could easily have been given a more reader-friendly title such …

Once upon and Algorithm - Martin Erwig ***

I've been itching to start reading this book for some time, as the premise was so intriguing - to inform the reader about computer science and algorithms using stories as analogies to understand the process.

This is exactly what Martin Erwig does, starting (as the cover suggests) with Hansel and Gretel, and then bringing in Sherlock Holmes (and particularly The Hound of the Baskervilles), Indiana Jones, the song 'Over the Rainbow' (more on that in a moment), Groundhog Day, Back to the Future and Harry Potter.

The idea is to show how some aspect of the story - in the case of Hansel and Gretel, laying a trail of stones/breadcrumbs, then attempting to follow them home - can be seen as a kind of algorithm or computation and gradually adding in computing standards, such as searching, queues and lists, loops, recursion and more.

This really would have been a brilliant book if Erwig had got himself a co-author who knew how to write for the public, but sadly the style is mostly heavy…