(Flickr photo (cropped) by Francis Bourgouin).

Medical mysteries are a source of fascination. On TV shows like Gray’s Anatomy or House, the patient’s life hangs in the balance until the correct diagnosis is reached. That is true in real life as well. Though many diagnoses are less dramatic than the televised versions, some are even more difficult. Appropriate treatment depends upon the correct diagnosis being made.
Guest: Lisa Sanders, MD, Clinical Instructor in Internal Medicine at Yale University School of Medicine. She writes the Diagnosis column for The New York Times Magazine. Her new book is: Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis.

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  1. I have had Lyme’s disease for many years, first undiagnosed ( it was not tested for). The biggest problem I have had is that our local well-known university says that Lymes does not exist in our state. This despite the fact that the vets are diagnosing many cases of Lymes locally (My dogs have it and have been treated).
    Still when the powers that be say a diagnosis is unacceptable, doctors will not go there. In addition, doctors that dare to test and treat these illnesses are threatened with punishment. I had to go out of state to find a doctor open minded enough to test me. I actually have three tick related illnesses. This is a case of doctors getting in their own way. Pride, arrogance, turf wars. The patient suffers. If this had been caught early I wouldn’t be as debilitated as I am now.

  2. Frankly, I wish they’d do fewer tests and were able to rely more on their clinical judgment. The problem is, they have incentives to do more tests–they can’t get sued for having done too many.
    MK I must disagree with your notion of patients choosing their own antibiotics (or any other medication). A physician is in the best position to judge whether a broad-spectrum or targeted drug will work best, and to weigh the risks and benefits of each in a particular condition. Half killing some of your bugs may actually put you at greater risk by not resolving your condition–not to mention encouraging the bugs to become resistant.
    I think you give physicians too little credit. MOST of them prescribe what they think will work best. I think it’s patients who are influenced by drug ads, not physicians, by and large, and they are in many cases informed enough to be dangerous (to themselves).
    If you have a physician who you think is prescribing for some kind of profit motive, perhaps you should find a different one.

  3. This broadcast troubled me somewhat. Especially with respect to the strep throat/Lemierre’s syndrome example there was not enough discussion about the role of tests. I often wonder why a physician will talk at great lengths about how he/she is saving me money by NOT performing a diagnostic test. Is there any reason that every person walking into a physician’s office with a sore throat should not receive a strep test?
    I wish physicians would rely more on objective testing than solely deciding whether I look “sick enough” to be have a specific illness — if the volume of tests were high enough perhaps the cost would decrease. An attitude that the procedure benefits folks 99% of the time is fine when a person is in the 99% but awful for the 1% who have fatal complications which might have been avoided with less of a mass production approach and more of an approach to really determine the illness.
    Also, I would like to have the choice of which antibiotic to use and not have a physician decide whether or not I would be “compliant” with a safer more effective antibiotic because it needed multiple doses. Given the choice, I would prefer a medication which was more broad band and/or safer. In many situations, I do not think that the patient is given enough choices but quickly dismissed. This leaves me wondering whether other factors have influence the physician such as vigorous marketing by drug companies, etc.

  4. I had a patient about ten years ago who had been to the ER the previous day complaining of chest pain referring down the arm, But his pain was focal, not diffuse. They ran up a $10,000 bill checking for heart attack. He left with the doctors not knowing why he had the pain.
    I found his problem and adjusted his rib and in less than an hour in my office with a bill of around $100 he left with his pain gone. He could not continue care for other problems we found in his spine because this uninsured man could not afford the minimal costs after accruing this enormous debt at the hospital.
    I called the head of the ER, told him what had happened and offered to come down and teach his staff how to recognize the difference between a heart attack and a rib subluxation. I never heard back from him. Would it be too cynical to think they had profited too much from their mistake to want to correct it?

  5. Great show, it raised a lot of good points about getting the correct diagnosis.
    Lisa menationed a throat problem often thought to be Strep called Lemays or Lamays. I Googled this and cannot find anything about it. Does someone have a link to a description of it or can correct my spelling so I can find it?
    Thanks!
    PEOPLE’S PHARMACY RESPONSE:
    Dr. Sanders had a wonderful piece in the New York Times Magazine section about Lemierre’s Disease some time back.
    Here is a link to Wikipedia:
    http://en.wikipedia.org/wiki/Lemierre's_syndrome
    Here is Dr. Sanders article:
    http://query.nytimes.com/gst/fullpage.html?res=9804E7D7103EF937A2575AC0A96E9C8B63&n=Top%2fFeatures%2fMagazine%2fColumns%2fDiagnosis

  6. Dr. House pops vicadin like candy, often with a chaser of burbon, yet never has any kidney or liver problems. Is this realistic?
    PEOPLE’S PHARMACY RESPONSE: NO, IT’S TELEVISION.

  7. I have one of those “illnesses that doctors can’t diagnose.” With a major in computer science/math and a minor in natural sciences (biochem) I have researched it myself and know the diagnosis and treatment. The next challenge is to get the doctors to listen to me; they won’t bring their noses down to my level, if it rained on them they’d drown. Them and their “god attitude”. Physical therapists agree with me, but my insurance won’t cover it and I can’t afford it.
    The pain doc must think I’m made of money. What I need is much weaker and cheaper than what she prescribes. I am extremely frustrated by the issue and strong emotions just make it worse. Pain often in the 8-10 range. I gave up on pain docs for about 6 months and just used Darvocette and “toughed it through”, which didn’t help. However, neither do pain docs and they cost much more.
    My insurance will cover 12 visits with a D.O. and I have an appointment with one who uses cold laser on Monday. I’ve read some things that indicate it might work. The problem is nerves trapped by adhesions from surgery six years ago. It’s hurt in 3 scars since them. One researcher thinks the lymph channels may be affected, too. Suggestions anyone??

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