The Art Of Medicine, kind of book review

I’ve read a couple books so far to get my mind in the mode of medicine. A couple of good ones and parts of a couple of dated ones. This is the most recent book and possibly the most influential so far, but perhaps it resonated with me because the book was preaching to the choir instead of giving a great truth. Still, I recommend it.

“The Art of Medicine: What Every Doctor and Patient Should Know” Kevin J. Soden, MD. Mosby, INC. 2003.

Read January 2008.

A pretty good book aimed at the premed & early medical student. It is well communicated almost to a fault giving a ting of new age education style that makes it impossible to miss the point. When he quotes a Study 3 times in the first 30 or so pages stating “When researchers studies how physicians arrived at a diagnosis in their patients, they found that history taking alone accounted for the correct diagnosis almost 70% of the time.” (xvii) , you find it impossible to miss the point and you don’t miss the point.

Thoroughly communicated, the book is well written enough to stay fresh. He uses story as a teaching tool, rather than pure lecture. He mixes slices of a young money-oriented medical student’s life as s/he becomes “emotional-income” oriented with his take on why the fictional events matter in the medical world.

What the medical student eventually learns is what Dr. Soden wants to teach. Using “the Seven Habits of Highly Effective People” by Covey as a starting point he stresses the need for quality communication with patients stressing the need for doctors to address not only physical health, but also at least inquire about spiritual health, mental and social health.

He also beats a common drum. Pressures put on by HMOs, insurance companies and higher patient expectations create more busy work for physicians and gives them less and less time to spend with their patients, causing a decreased quality care and decreased “emotional income” (gained through relationships with patients) creating intense burnout among physicians. Other than changing the system, physicians need to work on making sure that they are also “holistically” healthy keeping family and side interests as top priorities.

There are a number of interesting and practical pieces of advice Dr. Soden gives to physicians. Many times he gives lists of important questions many times he just gives an alternate perspective to a situation or a funny quote. Here are a few things that stuck out as things I wanted to remember:

 

“Body language and Facial expressions are independent of Culture.” (47)

“Average period of time before a physician interrupts a patient is only eighteen seconds.” (46)

Recommends learning to use tools rather than try and keep everything in your head.

Recommends keeping a medical journal to track and learn from your experiences as a doctor.

“The character Sherlock Holmes was a wonderful observer of life in general and of people in particular. In solving the various crimes presented to him, he always made some astute observation about people or the facts that everyone else had missed. They were in fact, very simple observations, but by putting them all together into a total picture he was able to make sense of things and solves a seemingly unsolvable mystery… Sherlock Holes was based on another English physician, Dr. John Bell.” (64)

“This masterpiece on loan from the Tate gallery in London and called the Doctor. It was painted by Sir Luke Fildes and was inspired by the memory of Fildes’ son. It’s a powerful description of the compassion that a physician can bring to a family, especially when there is nothing else that he has to offer in the way of treatment or aid.” (106

“A person without humor is like a wagon without springs, they are jolted by every bump in the road. (quote credited to Harriet Beecher Stowe)” (140)

“The Roman, Epicetus, said, “Man is not disturbed by events but by the view he takes of them.” (144)

 

“If a mother tells you that her child is sick or not acting normally, believe her until proven otherwise” (170) – mothers know their children best

“Sick kids look sick.” (171) – pay attention to body language

“Sir James Spence , a respected British physician, may have said it best: “The essential unit of medical practice is the occasion when in the intimacy of the consulting room or sick room, a person who is ill or believes himself to be ill, seeks advice of a doctor whom he trusts.” (219)

“The most important question to ask before you order ANYT test is ‘What will I do differently as a result of this test?’.” (227)

 

Tips to help your Doctor Make the Correct Diagnosis (77)

1. Think about your problem before seeing your doctor and write down all the pertinent facts so you don’t forget the most important things.

2. Decide what the key issues are that you want answered and prioritize them.

3. Think about your symptoms – when did they begin, how long do they last and what changes them for better, for worse.

4. Tell your story succinctly so that your doctor can ask questions to clarify your concerns.

5. Don’t be afraid to tell your doctor about the signs and symptoms that are bothering you even if he doesn’t specifically ask about them.

6. Do you mention anything that is different about you since your last visit because the change could be related to your medical problem or to a medicine you are taking.

 

9 diagnoses to always keep in mind (94)

Acute appendicitis

Aortic Aneurysm

Bacterial Meningitis

Ectopic pregnancy

Epiglottitis

Meningococcemia

Myocardial Infarction

Stoke

Testicular Torsion

 

Questions for Patients to ask when faces with a serious diagnosis (167)

1. What can I do to help myself cope with my diagnosis?
2. Where can I get more information about my problem?
3. Are there support groups or self-help groups that may provide additional information or support?
4. Are there other patients of your with a similar diagnosis that I might speak to who could help me?
5. Are there “alternative” medicine approaches that might help with my problem?

 

Patient’s Trust (221)

1. Do you think your doctor will do what ever it takes to provide all the care you need?
2. Do you believe you doctor only thinks about what is best for you?
3. Are his or her medical skills current and what you expect?
4. Is your doctor both thorough and careful?
5. Dopes your doctor pay full attention to you when you are telling your story?
6. Does you doctor provide you with all you treatment options for your particular medical problem?
7. Do you trust your doctor’s medical staff to tell you the truth and to look out after your best interests?
8. Are you willing to put your life in your doctor’s hands?

 

Questions for doctors to ask in spirituality:

1. Is religion or spirituality important to you in this illness?
2. Has faith been important to you at other times in your life?
3. Do you have someone to talk to about religious matters?
4. Would you like to explore religious matters with anyone?

 

Fulfilling relationships is what Dr. Soden thinks is number one in terms of keeping healthy and fresh.

 

10 ways to take Charge of Your life (307)

1. Always seek a mission in life that is grounded in a higher good and service to others.

2. Keep laughter and fun in all you do

3. Remember “when you felt the best in your life” and work toward keeping those experiences in your life.

4. Exercise regularly and take care of yourself

5. remain curious all your life and look for creative outlets.

6. Work at he important relationships in your life every day.

7. Find something you’re passionate about and work at it… outside the office

8. Seek Balance in your life

9. Set boundaries and delegates

10. Regularly examine how you feel emotionally and physically and if there are problems take corrective actions.

 

 

Find essays by Dr. John Bell, Dr. James Patcik O’Leary from LSU med center, Dr. Sherman Mellingkoff,

 

Things to keep in mind for patients:

Plan for end of life and emergency care

Let them know how to “get rid of the blues”.

Tags: advice to doctors, books, doctors, patients, quality in content, strategies, tactics, tid-bits