Diagnosis Solved! How to Solve a Medical Mystery
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Diagnosis Solved! How to Solve a Medical Mystery

Meet Lisa Sanders, MD, the real-life doctor behind the hit series House. As technical adviser to the show, author of The New York Times Magazine's "Diagnosis" column, and practicing internist at Yale University School of Medicine, Dr. Sanders knows a thing or two about medical mysteries. We caught up with her recently to talk about sleuthing your own symptoms and separating fact from fiction when doing health research online.

There's an overwhelming amount of health information available today. Should patients try to wade through it and research their symptoms, or should they just leave it to their doctor?

I would rather patients come in with a stack of 300 printouts from the Internet than say, "I don't know" when I ask them how they feel. Or I'll ask, "What medicines are you taking?" And they'll respond, "I don't know. I take a red one and a blue one and a capsule." When I see those patients my heart breaks because they don't know what's going on with their health, and they don't even realize it's their job to know.

Yes, I'm an advocate of using any and all available resources. The Internet is very useful simply because it lets you learn stuff. Knowledge is a powerful thing; it gives you a sense of command.

A lot of doctors wish their patients would just shut up and do what they say. But that's not really useful because then patients don't learn how to take responsibility for their own health. You have to be part of a team. I'm like the coach that helps you understand what's going on. But in the end, you're the one that has to fix the problem. And the more you know, and the more active role you play in your health, the better off you'll be.

How can people Google their health concerns and find information that's credible and useful?

If you're going to sleuth your symptoms, you have to be smart about it. If you Google the word headache, you're going to get 50 million hits and most of them aren't going to be useful. First you should find reliable sites. The National Institutes of Health site has very reliable information that lets you look up symptoms. The Mayo Clinic and Harvard University sites do as well. Those are some reputable sites that I use, but of course they're not the only ones. I'd say in general, you should get to know a place before you trust its content. Find out where they get the information and how they're supported. If they're supported by advertising dollars, that's fine, but you need to pay close attention to how much and in what context the advertisers are featured.

Now, sometimes you do need to dig for information outside of where you'd normally look, and Google is great at that. But if you only rely on the first few things that come up, you're going to get a lot of bad information. The trick is to be as specific as possible. Your doctor can help with this. A lot of times you go to the doctor with a symptom and all you leave with is the doctor's acknowledgment of the symptom. Maybe you don't get a diagnosis, but you might get a better name for that symptom. For example, let's say you have some pain in your shoulder. Your doctor might be able to tell you the name of the specific shoulder muscle that hurts, and then you can go home and research stretches for that particular muscle. Or you might go in with a rash. Your doctor might prescribe you a cream or something, but he or she probably won't mention the type of rash you have. So you've got to ask him what exactly is going on? When he says, "Oh, it's leukocytoclastic vasculitis," that may mean nothing to you. But get him to write it down so you can Google it when you get home. Then you can read about it all you want.

Less Obvious Symptoms

When you come down with a cold, for example, you usually know right away what's going on. But how do you decipher symptoms that are less obvious?

The first distinction you have to make is whether it's worth worrying about or not. My rule of thumb comes from something I learned in medical school: When a patient complains of a headache, there are three types of headaches worth worrying about: first, <worst, and cursed.

If it's the first, for example, if you don't have headaches but suddenly you're getting headaches all the time, you should see your doctor. Then, there's worst. If you have headaches but this is the worst headache you've ever had, then that is something to be concerned about. And last is cursed. Say you have headaches every so often, but now you also have blurry vision or another symptom that comes with the headaches. You should definitely see a doctor.

That's what we learned about headaches, but I think that for any symptom you might use "first, worst, and cursed" as a good way to judge what to worry about. Most of us are veterans when it comes to stomachaches, but if you've never had an upset stomach and now all of a sudden you do? That's worrisome. The same goes if it's the worst or if it's cursed with anything else out of the ordinary.

Are there any symptoms you should always worry about?

Yes, anything that involves blood or a loss of consciousness. Short of that, it gets subtle, but this reminds me of Dr. Benjamin Spock. The opening line of his famous book Baby and Child Care is, "You know more than you think you do."

And that's so true. Doctors understand diseases and bodies, sure, but patients are in fact the experts on their bodies and their disease. People are worried about their bodies, of course. We all know that this is all we have -- this is the wagon that we're in for life. And we want it to be well. But remember that when it's not well, your body will tell you.

That's what patients need to recognize: You know way more than you think you do. You know when you're sick. So if you're trying to decide whether you should go to the doctor, ask yourself, is there any blood involved? First, worst, cursed? Listen to your body, and if you feel like you need an expert's opinion, then see your doctor.

Talking to Your Doctor

In your book Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis, you say that talking to your doctor is the key to diagnosis. So why is it so hard for doctors and patients to just talk?

The problem is that too many doctors are under extreme pressure. But it's a pressure they've allowed themselves to be put under. The amount of money doctors get paid for visits has gone down quite a bit, and they've tried to make up for it the old-fashioned way -- by seeing more patients than ever before in a much shorter amount of time.

But as a patient, that's not your problem. You need a doctor who gives you the time you need. Now, if you need three hours, you're going to have a very hard time finding a doctor. But if you think you need more than six minutes? Welcome to the club. We all need more than six minutes.

Patients need to exert the same kind of pressures on doctors that insurance companies do. You have to say, "I need this, and I can't help that you've scheduled a patient every six minutes. This doesn't work for me."

Doctors do it because the pressure from the insurers is real. They are like our bosses, and they think we should see a patient every six minutes. But patients have got to apply pressure in the other direction. I think that ultimately insurance companies will see that a doctor's time, no matter how expensive it is, is way more useful than even the cheapest blood test, the cheapest scan, or the cheapest surgery. I hope they'll start to see that sooner rather than later. Doctors order many of these tests simply because they're under such time constraints, and they don't have time to listen to the patient and think about it. So they just decide to see what the test reveals and deal with it later.

Patients are the ones who suffer. Doctors need to have enough time to listen to their patients and hear what they have to say. There's no other way to get that information except by talking. Only the patients can say how they feel, what hurts, what makes it worse and what makes it better. Those are really fundamental questions that we as doctors ask, and there's no test for that! It's been shown in many studies that 80 percent of the time a diagnosis is made based on the patient's story.

The bottom line is that you need to find a doctor who will give you the time you need. And if that means voting with your feet and finding a different doctor, then that's what you have to do.

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