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When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests
In this examination of the doctor-patient relationship, Drs. Wen and Kosowsky argue that diagnosis, once the cornerstone of medicine, is fast becoming a lost art, with grave consequences.
Using real-life stories of cookbook-diagnoses-gone-bad, the doctors illustrate how active patient participation can prevent these mistakes. Wen and Kosowsky offer tangible follow-up questions patients can easily incorporate into every doctor's visit to avoid counterproductive and even potentially harmful tests. In the pursuit for the best medical care available, readers can't afford to miss out on these inside-tips and
▪ How to deal with a doctor who seems too busy to listen to you
▪ 8-Pillars to a Better Diagnosis
▪ How to tell the whole story of your illness
▪ Learning test risks and evaluating whether they're worth it
▪ How to get a working diagnosis at the end of every doctor's visit
By empowering patients to engage with their doctors as partners in their diagnosis, When Doctors Don't Listen is an essential guide that enables patients to speak up and take back control of their health care.
Using real-life stories of cookbook-diagnoses-gone-bad, the doctors illustrate how active patient participation can prevent these mistakes. Wen and Kosowsky offer tangible follow-up questions patients can easily incorporate into every doctor's visit to avoid counterproductive and even potentially harmful tests. In the pursuit for the best medical care available, readers can't afford to miss out on these inside-tips and
▪ How to deal with a doctor who seems too busy to listen to you
▪ 8-Pillars to a Better Diagnosis
▪ How to tell the whole story of your illness
▪ Learning test risks and evaluating whether they're worth it
▪ How to get a working diagnosis at the end of every doctor's visit
By empowering patients to engage with their doctors as partners in their diagnosis, When Doctors Don't Listen is an essential guide that enables patients to speak up and take back control of their health care.
352 pages, Paperback
First published January 8, 2013
63 people are currently reading
1319 people want to read
About the author
Leana Wen
3 books87 followersDr. Leana Wen is an emergency physician and public health professor at George Washington University. She is also a contributing columnist for the Washington Post and a CNN medical analyst.
Previously, she served as Baltimore’s health commissioner, where she led the nation’s oldest continuously-operating public health department.
She is the author of the book, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests (St. Martin’s Press, 2013) and a forthcoming memoir, Lifelines: A Doctor’s Journey in the Fight for Public Health (Metropolitan, July 2021).
Wen lives with her husband and two young children in Baltimore.
Previously, she served as Baltimore’s health commissioner, where she led the nation’s oldest continuously-operating public health department.
She is the author of the book, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests (St. Martin’s Press, 2013) and a forthcoming memoir, Lifelines: A Doctor’s Journey in the Fight for Public Health (Metropolitan, July 2021).
Wen lives with her husband and two young children in Baltimore.
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Displaying 1 - 30 of 49 reviews
February 21, 2014
This book by two Harvard physicians, Dr Leana Wen and Dr Joshua Kosowsky offers to diagnose what is wrong with the US healthcare system, attack the failures of "cookbook medicine", and increase patient self-advocacy.
This book fulfills these goals well. I recommend it as a good introduction for patients into the world of clinical reasoning and for doctors to review their practices. The book is peppered with extreme cases where cookbook medicine prevails over commonsense and patients were not empowered. However, I believe these are extreme cases and the connection between the bloated US healthcare system and cookbook medicine is not convincing.
The book does well to illustrate the system failures in many cases and suggests what the patient can do to take charge (respectfully) of their own health. The advice is sensible, if not a little unrealistic given the constraints of clinical practice. Yet doctors should strive to create an environment where patients can be effective partners in their healthcare.
My disagreement with this book is in its conclusion regarding cook book medicine. The fault, in my opinion, is not due to algorithms and care pathways, but rather to the very defensive nature of US medicine, the breakdown of the doctor-patient relationship, and the gulf between highly technical, statistical, and probabilistic scientific data and clinical practice. Even many doctors fail to grasp the meaning of much "clinical evidence" fully and thus will feel safe with a tried and trusted guideline.
The book recycles and rambles a little bit at some parts, but the cases make up well. Overall a good read.
This book fulfills these goals well. I recommend it as a good introduction for patients into the world of clinical reasoning and for doctors to review their practices. The book is peppered with extreme cases where cookbook medicine prevails over commonsense and patients were not empowered. However, I believe these are extreme cases and the connection between the bloated US healthcare system and cookbook medicine is not convincing.
The book does well to illustrate the system failures in many cases and suggests what the patient can do to take charge (respectfully) of their own health. The advice is sensible, if not a little unrealistic given the constraints of clinical practice. Yet doctors should strive to create an environment where patients can be effective partners in their healthcare.
My disagreement with this book is in its conclusion regarding cook book medicine. The fault, in my opinion, is not due to algorithms and care pathways, but rather to the very defensive nature of US medicine, the breakdown of the doctor-patient relationship, and the gulf between highly technical, statistical, and probabilistic scientific data and clinical practice. Even many doctors fail to grasp the meaning of much "clinical evidence" fully and thus will feel safe with a tried and trusted guideline.
The book recycles and rambles a little bit at some parts, but the cases make up well. Overall a good read.
December 20, 2013
I have worked in the healthcare field for almost 30 years. While I am not a physician I have seen first hand what Dr. Wen and Dr. Kosowsky describe in this most excellent book. These doctors have the guts and the fortitude to tell the real story, one that many physicians would rather not have their unsuspecting patients know.
I have worked in Healthcare Quality Management & Health Care Risk Management and tried to improve the quality, safety, and continuity of care that everyone deserves. It is so unfortunate that the KMS syndrome that you describe in your book not only applies to patients, but anyone who works in the healthcare system and tries to make positive changes is attacked by the same system.
The same patient safety issues that have been identified for years continue daily. They cause preventable medical errors and avoidable patient mortality, and cost billions of dollars. The fault lays not only with medical schools, but also nursing and allied health schools that are educating our future health care team of tomorrow. Students are graduating without the very basics of healthcare such as listening skills, common sense, and treating others the way you would want your family or yourself treated if you were the patient.
In the past ten years, I developed an incurable neuro-degenerative disorder and went from being healthy and hardly ever seeing a physician, to a patient-seeking healthcare. For several years I saw specialist after specialist, trying to have the practitioners listen to me about the symptoms I was experiencing. Because I wasn’t emphatic enough, and often kept my mouth shut, I suffered through countless painful and unnecessary tests and medications that made me sicker than my original symptoms.
I had to stop working in a career that I loved -- trying to make a difference in patient safety and patient outcomes. I had to spend two years finding the right physicians who would listen to my story, and work with me to reach a diagnosis and a treatment plan. Even as a healthcare professional myself, I felt helplessly trapped in the system and ready to give up. If I had trouble navigating the system, even with my experience and medical knowledge, I wonder what a layperson would do in the same situation.
I had read another book published by a physician called Unaccountable and then saw your blog and read your book. It made a major difference in my life.
It is physicians like Dr. Wen and Dr. Kosowsky who truly make a difference. Please ignore the very ignorant comments made by Practitioners who should not have chosen Medicine as a profession as they lack empathy, caring, and dedication to the Science and Art of Healthcare to help patients of today and tomorrow.
I have worked in Healthcare Quality Management & Health Care Risk Management and tried to improve the quality, safety, and continuity of care that everyone deserves. It is so unfortunate that the KMS syndrome that you describe in your book not only applies to patients, but anyone who works in the healthcare system and tries to make positive changes is attacked by the same system.
The same patient safety issues that have been identified for years continue daily. They cause preventable medical errors and avoidable patient mortality, and cost billions of dollars. The fault lays not only with medical schools, but also nursing and allied health schools that are educating our future health care team of tomorrow. Students are graduating without the very basics of healthcare such as listening skills, common sense, and treating others the way you would want your family or yourself treated if you were the patient.
In the past ten years, I developed an incurable neuro-degenerative disorder and went from being healthy and hardly ever seeing a physician, to a patient-seeking healthcare. For several years I saw specialist after specialist, trying to have the practitioners listen to me about the symptoms I was experiencing. Because I wasn’t emphatic enough, and often kept my mouth shut, I suffered through countless painful and unnecessary tests and medications that made me sicker than my original symptoms.
I had to stop working in a career that I loved -- trying to make a difference in patient safety and patient outcomes. I had to spend two years finding the right physicians who would listen to my story, and work with me to reach a diagnosis and a treatment plan. Even as a healthcare professional myself, I felt helplessly trapped in the system and ready to give up. If I had trouble navigating the system, even with my experience and medical knowledge, I wonder what a layperson would do in the same situation.
I had read another book published by a physician called Unaccountable and then saw your blog and read your book. It made a major difference in my life.
It is physicians like Dr. Wen and Dr. Kosowsky who truly make a difference. Please ignore the very ignorant comments made by Practitioners who should not have chosen Medicine as a profession as they lack empathy, caring, and dedication to the Science and Art of Healthcare to help patients of today and tomorrow.
January 16, 2013
I'm in the process of applying to medical school and also in the midst of an ongoing illness. As a patient, I appreciate the practical suggestions for questions to ask and conversations to have with your doctor. And as a future doctor, this book is a helpful guide for how to provide more effective care. It's engaging, easy to read and full of great stories. I think it's really easy to get caught up in testing as a doctor (or a patient), and this book helps to move us beyond that approach. I love the tone, too... this kind of book could get bogged down in an overly heavy tone, but the authors keep it lively.
July 3, 2014
“When Doctors Don’t Listen” is possibly the worst book ever written in the genre.
It is a calculated, deliberate, passive-aggressive doctor bashing book filled with ridiculously unrealistic case scenarios and hilariously contrived “scripts” that patients and doctors are advised to study and incorporate into their dialogue. The recommendations to doctors and patients alike are inane and repetitive and an insistence and call for doctors to provide “a diagnosis” to every patient is false and hollow because the authors fail to provide ANY direction or evidence of providing ANY form of diagnosis themselves. The book is full of condescension and platitudes and simply finishing the book is a tremendous effort.
First things first, much has been written about the importance of doctors and patients to improve communication, as that facilitates diagnosis and streamlines care plans and treatment. There – I’ve just summarized the entire book in one sentence. Three hundred pages of the same instruction repeated over and over again is patronizing and unnecessary.
The authors provide factually inaccurate and patently ridiculous case scenarios to emphasize their focus on the importance of history taking. For instance, the authors describe a 60-ish year old man (just happens to be an attorney) that develops an abrupt, change in mental status with seeming confusion and perseveration that is witnessed by an entire courtroom of people. After an exhaustive (and appropriate) workup including advanced neuroimaging, the patient is diagnosed with “transient global amnesia” and the authors attempt to make the argument that the patient’s ultimate diagnosis should have been evident based on his presenting symptoms and a careful review of the circumstances of his presentation. Oh – if only all doctors were as brilliant as these authors – medicine wouldn’t be as expensive or as wasteful as it is and no doctor would ever get sued and patients would never need to be told to lose weight or quit smoking, because their brilliant doctors would just decree and proclaim and it would be so. There are other, equally as banal and absurd case scenarios scattered throughout the book that do nothing for the doctor-patient dialogue except to introduce doubt on the part of the patient into virtually every decision that a doctor makes.
The doctor-bashing in this book is not subtle – in fact there is one section near the end of the book in which “patient questions” are entertained and one question, on page 273, asks “It seems like it would take a lot of brainpower to become good at this kind of medicine and actually provide patients diagnoses. What if the average physician just isn’t smart enough to do it?” As a physician myself, I wanted to throw the book across the room. As it was, I choose to share several chapters of the book with my colleagues and watched THEM throw the pages across the room. The authors will accuse me of taking this question out of context or neglecting to include the answer to the question. The answer to the question includes the sentence “For doctors already in practice, relearning a personalized partnership approach to patient care will be difficult. It requires changing an entire mindset and approaching patient care in a whole different way.” There are entire sections of the book devoted to instructing patients what they should do should they suspect that their doctor just isn’t bright enough to be asking the appropriate questions. The authors assume that the doctors are just too dumb to do things the correct (i.e. their) way or the patients are too dumb to recognize that they are unhappy with their doctor and simply find another one. Perhaps the authors don’t spend enough time talking with their own patients because mine are very honest and blunt when they report to me that they aren’t happy with their own doctors and ask me to be their primary care provider instead of just their “ER doctor.” The authors have very little respect for the patients they discuss or the doctors that they throw under the bus.
Perhaps the most obnoxious element of this exceedingly obnoxious book is the insistence that patients never leave their doctors’ office without a “diagnosis.” The authors really take doctors to task for not providing a diagnosis for their patients but in the book never actually provide any demonstrable diagnosis to any of their patients either.
Let me day that again – these authors criticize doctors for NOT providing diagnoses and yet FAIL to provide a diagnosis for any of the analogous examples in their book.
I had an opportunity to ask Dr. Krosowsky in person about this and his response was an explanation of how he educates and instructs his patients on the probable lists of diagnostic possibilities and shares with them the next logical steps in the work-up. When I pointed out to him that he wasn’t actually providing a diagnosis for his patients – just a thoughtful consideration of the differential possibilities, he strongly disagreed with me and insisted that he was indeed providing a diagnosis, as outlined in his book. When I asked him whether or not he believed that the same conversation occurs between every patient and every doctor he all but laughed out loud at the suggestion. Dr. Krosowsky clearly does not believe that doctors have conversations with their patients about the possible diagnostic considerations for a complaint or ailment, which is a glimpse into his motivation behind writing this terrible little book.
His co-author’s motivation is more easily discerned. This book is designed and calculated for Dr. Wen to generate outrageous speaking fees at hospitals and medical schools around the country that are foolish enough to invite her to discuss this awful little book and to appear on as many “Oprah” and “Good Morning America” type shows on which her agent can get her booked and on which she can continue to throw doctors under the bus. As evidence of that design, just check out her website “The Doctor Is Listening.com” and try to maintain a straight face.
It is a calculated, deliberate, passive-aggressive doctor bashing book filled with ridiculously unrealistic case scenarios and hilariously contrived “scripts” that patients and doctors are advised to study and incorporate into their dialogue. The recommendations to doctors and patients alike are inane and repetitive and an insistence and call for doctors to provide “a diagnosis” to every patient is false and hollow because the authors fail to provide ANY direction or evidence of providing ANY form of diagnosis themselves. The book is full of condescension and platitudes and simply finishing the book is a tremendous effort.
First things first, much has been written about the importance of doctors and patients to improve communication, as that facilitates diagnosis and streamlines care plans and treatment. There – I’ve just summarized the entire book in one sentence. Three hundred pages of the same instruction repeated over and over again is patronizing and unnecessary.
The authors provide factually inaccurate and patently ridiculous case scenarios to emphasize their focus on the importance of history taking. For instance, the authors describe a 60-ish year old man (just happens to be an attorney) that develops an abrupt, change in mental status with seeming confusion and perseveration that is witnessed by an entire courtroom of people. After an exhaustive (and appropriate) workup including advanced neuroimaging, the patient is diagnosed with “transient global amnesia” and the authors attempt to make the argument that the patient’s ultimate diagnosis should have been evident based on his presenting symptoms and a careful review of the circumstances of his presentation. Oh – if only all doctors were as brilliant as these authors – medicine wouldn’t be as expensive or as wasteful as it is and no doctor would ever get sued and patients would never need to be told to lose weight or quit smoking, because their brilliant doctors would just decree and proclaim and it would be so. There are other, equally as banal and absurd case scenarios scattered throughout the book that do nothing for the doctor-patient dialogue except to introduce doubt on the part of the patient into virtually every decision that a doctor makes.
The doctor-bashing in this book is not subtle – in fact there is one section near the end of the book in which “patient questions” are entertained and one question, on page 273, asks “It seems like it would take a lot of brainpower to become good at this kind of medicine and actually provide patients diagnoses. What if the average physician just isn’t smart enough to do it?” As a physician myself, I wanted to throw the book across the room. As it was, I choose to share several chapters of the book with my colleagues and watched THEM throw the pages across the room. The authors will accuse me of taking this question out of context or neglecting to include the answer to the question. The answer to the question includes the sentence “For doctors already in practice, relearning a personalized partnership approach to patient care will be difficult. It requires changing an entire mindset and approaching patient care in a whole different way.” There are entire sections of the book devoted to instructing patients what they should do should they suspect that their doctor just isn’t bright enough to be asking the appropriate questions. The authors assume that the doctors are just too dumb to do things the correct (i.e. their) way or the patients are too dumb to recognize that they are unhappy with their doctor and simply find another one. Perhaps the authors don’t spend enough time talking with their own patients because mine are very honest and blunt when they report to me that they aren’t happy with their own doctors and ask me to be their primary care provider instead of just their “ER doctor.” The authors have very little respect for the patients they discuss or the doctors that they throw under the bus.
Perhaps the most obnoxious element of this exceedingly obnoxious book is the insistence that patients never leave their doctors’ office without a “diagnosis.” The authors really take doctors to task for not providing a diagnosis for their patients but in the book never actually provide any demonstrable diagnosis to any of their patients either.
Let me day that again – these authors criticize doctors for NOT providing diagnoses and yet FAIL to provide a diagnosis for any of the analogous examples in their book.
I had an opportunity to ask Dr. Krosowsky in person about this and his response was an explanation of how he educates and instructs his patients on the probable lists of diagnostic possibilities and shares with them the next logical steps in the work-up. When I pointed out to him that he wasn’t actually providing a diagnosis for his patients – just a thoughtful consideration of the differential possibilities, he strongly disagreed with me and insisted that he was indeed providing a diagnosis, as outlined in his book. When I asked him whether or not he believed that the same conversation occurs between every patient and every doctor he all but laughed out loud at the suggestion. Dr. Krosowsky clearly does not believe that doctors have conversations with their patients about the possible diagnostic considerations for a complaint or ailment, which is a glimpse into his motivation behind writing this terrible little book.
His co-author’s motivation is more easily discerned. This book is designed and calculated for Dr. Wen to generate outrageous speaking fees at hospitals and medical schools around the country that are foolish enough to invite her to discuss this awful little book and to appear on as many “Oprah” and “Good Morning America” type shows on which her agent can get her booked and on which she can continue to throw doctors under the bus. As evidence of that design, just check out her website “The Doctor Is Listening.com” and try to maintain a straight face.
April 9, 2021
To diagnose what a patient has requires more than just what the doctor sees, feels, or tests. It requires the voice of the patient. The history of the ailment is extremely important to understand what may be causing it. When doctors don’t listen to their patients, they start to order unnecessary tests and worse still, misdiagnose the problem. Rather than listen to their patient, doctors rely on pathways, cookbook algorithms that rule out possible causes which doctors believe will reduce the chance of malpractice suits. But by over-relying on cookbook algorithms and unnecessary tests, they not only create undue stress, but misdiagnose and take more time to get to the appropriate diagnoses. This is a book for patients to learn that they are partners in their heath care, and for doctors to understand that the patient’s voice is a very valuable source of vital information.
A vital part of medical care is the diagnosis. The diagnosis is what the patient has that needs to be treated. Communicating the history of the symptoms and related info provides the doctor with resources to make the diagnosis. When doctors don’t listen, they do not obtain the information that can make a change the possible diagnosis. If a diagnosis doesn’t make sense, the patient should help the doctor perform a commonsense check, to make sure the symptoms align with the diagnosis. Better to rectify a misunderstanding earlier than to get pulled into a wrong diagnosis. A diagnosis is not the ruled out worst case scenarios. This book provides a guideline how patients can better communicate with their doctors, and for doctors to learn how to better understand how to talk with patients.
The history of medicine had practitioner engage with the patient to alleviate the patients’ ailments. The techniques were inferior and specious, but the care in partnership with the patient and directed at alleviating patients’ woes. During the 20th century, doctors have gotten two updates which are, 1) a lot more technical tools to use, 2) more formalistic approach to medicine. With the ability to run tests easily, doctors started to use testing rather than rely on patients’ medical history. Tests are used as proxy for decision making rather than to supplement decisions. The cookbook formalistic approach was meant to make the system more systematic and efficient, but doctors started to use the pathways to rule out possible ailments rather than focus on what the patient actually has. In combination, doctors order unnecessary tests and misdiagnose causing massive inefficiency and lowering medical care quality. Rather than diagnoses, the doctors tell patients what they do not have.
Part of the reason that doctors order unnecessary tests is out of defensive medicine. Doctors order many tests to make sure that they are covered. As in the tests and routines are thought of as protecting the doctor from malpractice lawyers, as the doctor can claim they followed the standard of care. However improbable a particular diagnosis is, fear of missing the improbable dominates decision making to the exclusion of patients best-interest. This system leads to over testing and under diagnosing, with the irony of more suits. What reduces malpractice suits is actually listening to what the patient has to say and treating them as partners in health. Tests themselves carry risks such as a CT scan puts the patient under a lot of radiation that increases the risk of cancer. Patients should ask questions about the tests and of there are alternatives.
Cookbook medicine is when a doctor follows a strict algorithm, a pathway. Problems start to occur when the doctor listens for a chief complain to use for a pathway, without listening for more information. Emphasizing the chief complaint without additional information leads to misdiagnosis because the pathway chosen is not tailored to any given individual. Chief complaints are usually used as a starting point to rule out ailments rather than diagnose the actual ailment. When a patient is on a pathway, it obtains inertia, making it hard stop following the pathway as it then requires more justification to stop. Pathways themselves miss a lot because it is a focus on a singular problem, rather than considering all potential problems.
Technology and pathways are useful given that the doctor actually has information which indicates the appropriate diagnosis in which case following procedure is best which leads to testing for particular ailments rather than ruling out ailments. The authors of this book are not asking for patients to mistrust doctors, that technology is useless or should not be used, or that routine has no place in medical practice. Doctors’ knowledge and experience, technology, and routine have a lot of use when put into appropriate context. But by not seeing the patient as a partner in health, medical tools are not only less effective, but can be detrimental.
A vital part of medical care is the diagnosis. The diagnosis is what the patient has that needs to be treated. Communicating the history of the symptoms and related info provides the doctor with resources to make the diagnosis. When doctors don’t listen, they do not obtain the information that can make a change the possible diagnosis. If a diagnosis doesn’t make sense, the patient should help the doctor perform a commonsense check, to make sure the symptoms align with the diagnosis. Better to rectify a misunderstanding earlier than to get pulled into a wrong diagnosis. A diagnosis is not the ruled out worst case scenarios. This book provides a guideline how patients can better communicate with their doctors, and for doctors to learn how to better understand how to talk with patients.
The history of medicine had practitioner engage with the patient to alleviate the patients’ ailments. The techniques were inferior and specious, but the care in partnership with the patient and directed at alleviating patients’ woes. During the 20th century, doctors have gotten two updates which are, 1) a lot more technical tools to use, 2) more formalistic approach to medicine. With the ability to run tests easily, doctors started to use testing rather than rely on patients’ medical history. Tests are used as proxy for decision making rather than to supplement decisions. The cookbook formalistic approach was meant to make the system more systematic and efficient, but doctors started to use the pathways to rule out possible ailments rather than focus on what the patient actually has. In combination, doctors order unnecessary tests and misdiagnose causing massive inefficiency and lowering medical care quality. Rather than diagnoses, the doctors tell patients what they do not have.
Part of the reason that doctors order unnecessary tests is out of defensive medicine. Doctors order many tests to make sure that they are covered. As in the tests and routines are thought of as protecting the doctor from malpractice lawyers, as the doctor can claim they followed the standard of care. However improbable a particular diagnosis is, fear of missing the improbable dominates decision making to the exclusion of patients best-interest. This system leads to over testing and under diagnosing, with the irony of more suits. What reduces malpractice suits is actually listening to what the patient has to say and treating them as partners in health. Tests themselves carry risks such as a CT scan puts the patient under a lot of radiation that increases the risk of cancer. Patients should ask questions about the tests and of there are alternatives.
Cookbook medicine is when a doctor follows a strict algorithm, a pathway. Problems start to occur when the doctor listens for a chief complain to use for a pathway, without listening for more information. Emphasizing the chief complaint without additional information leads to misdiagnosis because the pathway chosen is not tailored to any given individual. Chief complaints are usually used as a starting point to rule out ailments rather than diagnose the actual ailment. When a patient is on a pathway, it obtains inertia, making it hard stop following the pathway as it then requires more justification to stop. Pathways themselves miss a lot because it is a focus on a singular problem, rather than considering all potential problems.
Technology and pathways are useful given that the doctor actually has information which indicates the appropriate diagnosis in which case following procedure is best which leads to testing for particular ailments rather than ruling out ailments. The authors of this book are not asking for patients to mistrust doctors, that technology is useless or should not be used, or that routine has no place in medical practice. Doctors’ knowledge and experience, technology, and routine have a lot of use when put into appropriate context. But by not seeing the patient as a partner in health, medical tools are not only less effective, but can be detrimental.
February 25, 2013
I picked up the book, read the dust cover and was prepared to be underwhelmed. Over the last three years I have participated in an aviation safety conference which has expanded its invitation list to include the medical profession as well as other fields. During these conferences I was struck by how all industries have improved production processes, aviation safety, and patient care by adapting and refining quality control methods. This approach has been embraced and implanted into many industries over the last fifteen years. These industries have reaped significant measurable benefits from putting the recipe/cookie cutter approach into place. The approach reduces variation, is less dependent on individual practitioner expertise. This is what I thought the two good doctors would be suggesting tossing out, but they didn't. They recognized some of the benefits of standardized processes, but want the improvement of additional personal involvement of patient and physician in the diagnostic process, which seems to me to be a balanced approach and a great answer to the question, "Okay, we've standardized our processes. Now what do we do?"
Good book. Give it a read.
Good book. Give it a read.
January 12, 2013
I was surprised by how much I would enjoy this book. I'm not normally someone who reads nonfiction medical books, but this was recommended to me by a friend of a friend. It's a fantastic read, with lots of interesting stories that illustrate what is wrong with the healthcare system and how it affects each of us. Healthcare today makes patients feel utterly out of control and powerless, and this book contains lots of tips like the 8 Pillars to Better Diagnosis for empowering patients to take back control. It's well-written with memorable anecdotes and filled with useful advice. I highly recommend it anyone who has ever seen a doctor or will plan to see one.
August 20, 2015
I received this as a first read. This one had some interesting information that could help in a health crisis. The author definitely did the research. Also the information is written in a easy to consume format. However, the book also could be a little heavy handed about the distrust with the medical profession.
April 21, 2013
Underestimates many doctors I know who definitely do not practice cookbook medicine. That being said, gives valuable insight to the "layperson" and hopefully will help bridge the divide between patient and healthcare provider.
December 25, 2014
A very good book! Medical schools teach doctors how to deal with patients - this book teaches patients how to deal with doctors. Very good ideas for how to get your point across, how to make sure you get the right diagnosis, and how to avoid having all those endless tests.
September 6, 2013
Does not accurately describe the practice of most physicians, and advises distrust by patients.
June 21, 2024
There are many books about how the American medical care system is a shambolic mess that costs way too much while delivering inferior results. This one claims that the solution to fixing it is for patients to learn how to manage their doctors (in particular in the Emergency Room). While I appreciate the authors' frustrations and agree with many of their points, their proposal overall seems like a bad idea for a number of reasons.
-It should not be up to patients (in the middle of an emergency!) to think more clearly than their doctors about how to practice medicine. That seems like victim-blaming to me for why people get bad care.
-The whole book is an attack on "cookbook medicine." At the very end, there's a brief Q&A section that brings up things like The Checklist Manifesto: How to Get Things Right and the Ottawa Ankle Rules. The authors then admit that Yes indeed these are examples of excellent cookbook medicine. So the problem is not cookbook medicine or guidelines per se--it's stupid guidelines stupidly implemented.
-Since "cookbook medicine" is a derogatory term used to label Evidence-Based Medicine, their language is I think very dangerous because it amounts rhetorically to an attack on evidence-based practice. I find it bizarre and troubling that a book about improving medical outcomes doesn't even have the word "evidence" in the index.
-The book is told largely in the form of anecdotes and commentary. It would have been nice to have some hard evidence that adopting their approach improves outcomes and saves costs.
-Doctors practice the way they do becasue they are trained to practice this way. The academic medical centers need to train doctors in basic skills like clinical reasoning (not just generating a long differntial diagnosis) in addition to history-taking and physical examination. And especially now with a world of knowldedge in your pocket, they should be trained to look things up when something doesn't fit with their first diagnosis. This Sherlock Holmes aspect should be fun and part of the reason for becoming a doctor.
-The anecdotes given didn't have enough details to properly illustrate relevant points. For example, the guy with testicular torsion who was worked up for rule out appendicitis, etc. It's probably the case that appendicitis was not a likely diagnosis even before any shotgun testing was ordered. It's okay to think of appendicitis first, but then the doctor should let go of that if it doesn't fit and consider other causes.
-The book is a dozen years old now. Things seem even worse. We are heading toward robots applying these stupid algorithms and eliminating doctors. Reform is needed.
If you want to do what they are talking about:
The Common Symptom Guide, Sixth Edition
-It should not be up to patients (in the middle of an emergency!) to think more clearly than their doctors about how to practice medicine. That seems like victim-blaming to me for why people get bad care.
-The whole book is an attack on "cookbook medicine." At the very end, there's a brief Q&A section that brings up things like The Checklist Manifesto: How to Get Things Right and the Ottawa Ankle Rules. The authors then admit that Yes indeed these are examples of excellent cookbook medicine. So the problem is not cookbook medicine or guidelines per se--it's stupid guidelines stupidly implemented.
-Since "cookbook medicine" is a derogatory term used to label Evidence-Based Medicine, their language is I think very dangerous because it amounts rhetorically to an attack on evidence-based practice. I find it bizarre and troubling that a book about improving medical outcomes doesn't even have the word "evidence" in the index.
-The book is told largely in the form of anecdotes and commentary. It would have been nice to have some hard evidence that adopting their approach improves outcomes and saves costs.
-Doctors practice the way they do becasue they are trained to practice this way. The academic medical centers need to train doctors in basic skills like clinical reasoning (not just generating a long differntial diagnosis) in addition to history-taking and physical examination. And especially now with a world of knowldedge in your pocket, they should be trained to look things up when something doesn't fit with their first diagnosis. This Sherlock Holmes aspect should be fun and part of the reason for becoming a doctor.
-The anecdotes given didn't have enough details to properly illustrate relevant points. For example, the guy with testicular torsion who was worked up for rule out appendicitis, etc. It's probably the case that appendicitis was not a likely diagnosis even before any shotgun testing was ordered. It's okay to think of appendicitis first, but then the doctor should let go of that if it doesn't fit and consider other causes.
-The book is a dozen years old now. Things seem even worse. We are heading toward robots applying these stupid algorithms and eliminating doctors. Reform is needed.
If you want to do what they are talking about:
The Common Symptom Guide, Sixth Edition
September 14, 2018
Good book. More positive than I thought it would be. Almost all of the stories ended with an outcome that wasn't too bad: the patient was inconvenienced but ultimately lived without serious repercussions. There was only one story of a woman who died possibly unnecessarily. This book is remarkably clear-eyed: it admits that yes, doctors should be the ones seeing the whole picture instead of jumping to conclusions; however, given that health care isn't changing any time soon, here's what patients can do. It was helpful to know that clinicians are taught to identify a "chief complaint," that they tend to funnel people into "pathways" regardless of whether the things they are testing for are likely. It does seem like people have assumed that I have something that they specialize in, even when the symptoms or the mechanism of injury don't match in the slightest. I liked the idea of bringing up what you are worried that your symptoms might indicate when you go to the doctor - this is a big part of how the patient feels afterward, but doctors never ask about it.
My favorite part of the book was when they retold the patient stories suggesting a way that those patients could politely remain undeterred while repeating the symptoms the doctor ignored, and refusing to be rushed into tests for no reason. Yes, to some extent those retold stories did seem a bit like a fairy-tale because what patient could stay that calm and reasonable while being sick? Also, I can't say I've had doctors react well to me suggesting alternative diagnoses ... though I probably wasn't very polite when I did. (It's hard to be polite when they are saying things that are completely nonsensical.) But I really liked seeing the model of how such a conversation could work.
I also found the exercises at the end cool. One was hysterical: "Ask a trusted friend to play the role of a hurried and obnoxious 'doctor' [...] Tell them about your last vacation [...] Instruct your friend ahead of time to be as rude as possible and to interrupt you frequently with yes/no or other close-ended questions." p290. Funny and sad ... I probably won't do most of the exercises (even though they would all probably be helpful) but I might talk someone into trying this one with me. It's a good skill to have, "deflecting the questions and redirecting your friend so that you return to the story."
My favorite part of the book was when they retold the patient stories suggesting a way that those patients could politely remain undeterred while repeating the symptoms the doctor ignored, and refusing to be rushed into tests for no reason. Yes, to some extent those retold stories did seem a bit like a fairy-tale because what patient could stay that calm and reasonable while being sick? Also, I can't say I've had doctors react well to me suggesting alternative diagnoses ... though I probably wasn't very polite when I did. (It's hard to be polite when they are saying things that are completely nonsensical.) But I really liked seeing the model of how such a conversation could work.
I also found the exercises at the end cool. One was hysterical: "Ask a trusted friend to play the role of a hurried and obnoxious 'doctor' [...] Tell them about your last vacation [...] Instruct your friend ahead of time to be as rude as possible and to interrupt you frequently with yes/no or other close-ended questions." p290. Funny and sad ... I probably won't do most of the exercises (even though they would all probably be helpful) but I might talk someone into trying this one with me. It's a good skill to have, "deflecting the questions and redirecting your friend so that you return to the story."
April 22, 2023
Would've given it 4.5 stars if I could!
I really like how this was presented - from the perspective of a physician, teaching patients how they should become partners in their diagnostic and treatment journey, not leaving everything to the physicians. Good reminder for physicians in taking history, that we should be having a conversation with the patient, and not carrying out an interrogation by asking close-ended questions which have limited value and may not get us very far. We should not be fixated on the chief complaint and start to practise cookbook medicine according to set protocols - use common sense!
Five things in the book stuck with me:
1) When we say the patient is a "poor historian", is it because we are poor "history-takers"? The good clinician should always find a way to figure out the patient's story.
2) The "No Questions Asked" game that the physician-educator played with his medical students to train them to take history with opening statements (vs close-ended questions). Ever since I read this, it's been on my mind every time I see a patient. I think it's practice-changing!
3) As an attending, do not delegate the patient-doctor relationship to someone else. Always explain if there is a difference in opinion between providers, so that the patient isn't confused.
4) Extra care (more tests) doesn't mean better care. We must understand why a test should be ordered in the first place, otherwise there can be significant delay in getting to the right diagnosis without applying the correct test.
5) CT scans are the last refuge of the intellectually destitute (hahaha)
As a patient (which we all are at some point), the book provides useful prescriptive exercises for u to practise interacting (politely) with the physician, to ask questions along the way so that you can be involved in your care and understand what is being done and why. I think we all need that.
I really like how this was presented - from the perspective of a physician, teaching patients how they should become partners in their diagnostic and treatment journey, not leaving everything to the physicians. Good reminder for physicians in taking history, that we should be having a conversation with the patient, and not carrying out an interrogation by asking close-ended questions which have limited value and may not get us very far. We should not be fixated on the chief complaint and start to practise cookbook medicine according to set protocols - use common sense!
Five things in the book stuck with me:
1) When we say the patient is a "poor historian", is it because we are poor "history-takers"? The good clinician should always find a way to figure out the patient's story.
2) The "No Questions Asked" game that the physician-educator played with his medical students to train them to take history with opening statements (vs close-ended questions). Ever since I read this, it's been on my mind every time I see a patient. I think it's practice-changing!
3) As an attending, do not delegate the patient-doctor relationship to someone else. Always explain if there is a difference in opinion between providers, so that the patient isn't confused.
4) Extra care (more tests) doesn't mean better care. We must understand why a test should be ordered in the first place, otherwise there can be significant delay in getting to the right diagnosis without applying the correct test.
5) CT scans are the last refuge of the intellectually destitute (hahaha)
As a patient (which we all are at some point), the book provides useful prescriptive exercises for u to practise interacting (politely) with the physician, to ask questions along the way so that you can be involved in your care and understand what is being done and why. I think we all need that.
August 19, 2017
An educational book for both patients and health professionals.
This book is full of insights as to how the way we have changed the physician-patient relationship has been detrimental to the patient, and what the patient can do to help change it. In medical schools for decades doctors have been taught "cookbook medicine" which means that they follow pathways and algorithms as opposed to listening carefully to their patient, coming up with a proper differential diagnosis, and then coming up with a plan for the proper tests that will help both the doctor and patient find the true diagnosis. It was an extremely interesting and insightful read and I am very excited to implement the tools that the authors discuss. Practice will certainly be necessary, as many people are not used to speaking up to doctors when they are confused, have questions, or disagree.
In truth, I think this book is helpful for everyone as we all find ourselves in the ER or PCP's office from time to time (or more frequently) and there are many doctors who need to relearn the skills detailed in this book. This book should certainly be mandatory reading for anyone in or going into medicine, whether it is a nurse, social worker, or doctor.
The best part about this book is that it is an interesting read. With the case studies/stories of the different patients, their experiences, the details of the errors of both the health care professionals and the way patients could have helped themselves get better care help to illustrate their points with poignant examples while still remaining entertaining. It is a feat, and a necessary piece of writing.
This book is full of insights as to how the way we have changed the physician-patient relationship has been detrimental to the patient, and what the patient can do to help change it. In medical schools for decades doctors have been taught "cookbook medicine" which means that they follow pathways and algorithms as opposed to listening carefully to their patient, coming up with a proper differential diagnosis, and then coming up with a plan for the proper tests that will help both the doctor and patient find the true diagnosis. It was an extremely interesting and insightful read and I am very excited to implement the tools that the authors discuss. Practice will certainly be necessary, as many people are not used to speaking up to doctors when they are confused, have questions, or disagree.
In truth, I think this book is helpful for everyone as we all find ourselves in the ER or PCP's office from time to time (or more frequently) and there are many doctors who need to relearn the skills detailed in this book. This book should certainly be mandatory reading for anyone in or going into medicine, whether it is a nurse, social worker, or doctor.
The best part about this book is that it is an interesting read. With the case studies/stories of the different patients, their experiences, the details of the errors of both the health care professionals and the way patients could have helped themselves get better care help to illustrate their points with poignant examples while still remaining entertaining. It is a feat, and a necessary piece of writing.
April 13, 2025
The authors first explain how doctors and medical personnel are taught to diagnose a condition by examining symptoms, using an algorithm or ‘cookbook’ system. However, the book also gives examples of how these “pathways” can backfire, leading to unnecessary tests and incorrect diagnoses. Often the medical staff wants to rule out a possible worst-case scenario, rather than taking the extra effort to determine the correct diagnosis.
Throughout the book, the authors provide useful questions for the reader/patient to help make sure the medical staff is thinking in the right direction. Also included are suggestions for medical personnel who want to adjust their techniques. The authors emphasize that the book is not an indictment of the doctors themselves, but of the healthcare system, and their goal is to help the patient work with the doctor for a more positive outcome through “collaborative problem solving.” So don’t be afraid to ask questions...it’s your body—and sometimes your life!
An excellent, practical book, full of helpful suggestions. As it can take some time for non-medical people to get used to the process, the book also includes a pre-visit worksheet that might help in determining a diagnosis.
Throughout the book, the authors provide useful questions for the reader/patient to help make sure the medical staff is thinking in the right direction. Also included are suggestions for medical personnel who want to adjust their techniques. The authors emphasize that the book is not an indictment of the doctors themselves, but of the healthcare system, and their goal is to help the patient work with the doctor for a more positive outcome through “collaborative problem solving.” So don’t be afraid to ask questions...it’s your body—and sometimes your life!
An excellent, practical book, full of helpful suggestions. As it can take some time for non-medical people to get used to the process, the book also includes a pre-visit worksheet that might help in determining a diagnosis.
June 29, 2019
The book provides a good introduction to healthcare today from the perspectives of the emergency room and the over-abundance of diagnostic testing. As a patient or future patient, it can be very helpful at preparing for your next encounter with the healthcare system. As a healthcare professional (or healthcare student), it can be helpful for reorienting your clinical approach to enhance your patient-centeredness.
However, the book is much longer than it needs to be, leading to some redundancies of topics. Also, the cases are almost entirely focused on acute care issues, that it really only speaks best to that cross-section of today’s healthcare system. In the authors’ defense, this is their practice area and this is also an area of overspending & over-testing. However, the incorporation of a primary care / chronic care perspective is a large part of the conversation that is missing in the national dialogue, and entirely absent from this book. There is a lot of shared decision making that needs to occur beyond the initial testing and diagnosis to make our healthcare system more efficient; perhaps that is the theme of a sequel?
However, the book is much longer than it needs to be, leading to some redundancies of topics. Also, the cases are almost entirely focused on acute care issues, that it really only speaks best to that cross-section of today’s healthcare system. In the authors’ defense, this is their practice area and this is also an area of overspending & over-testing. However, the incorporation of a primary care / chronic care perspective is a large part of the conversation that is missing in the national dialogue, and entirely absent from this book. There is a lot of shared decision making that needs to occur beyond the initial testing and diagnosis to make our healthcare system more efficient; perhaps that is the theme of a sequel?
November 17, 2021
This book takes a systematic approach to talking with your doctor and discussed how medicine has become a “shot gun” approach rather than a “get to know the patient and understand why they don’t feel well”.
This book is practical (thought sometimes I think that having conversations the way they’re portrayed is sometimes seemingly unrealistic, but at least a good foundation), taking real world scenarios and pointing out the flaws and positive points of interactions between patient and physician. This was great for not only patients to self-advocate appropriately, but for physicians to take a step back and rethink the way they’ve been practicing medicine.
While some repeating points, I think this is important because it really drives home the point of making sure you get the level of care you desire which is getting a diagnosis that is appropriate and you leave the doctors office, ER, or urgent care feeling better.
If I was a physician, I’d have this book with me all the time as a constant reminder that while systems and pathways and checklists are in place so that nothing is missed, taking the extra time to hear our your patient is just as important.
This book is practical (thought sometimes I think that having conversations the way they’re portrayed is sometimes seemingly unrealistic, but at least a good foundation), taking real world scenarios and pointing out the flaws and positive points of interactions between patient and physician. This was great for not only patients to self-advocate appropriately, but for physicians to take a step back and rethink the way they’ve been practicing medicine.
While some repeating points, I think this is important because it really drives home the point of making sure you get the level of care you desire which is getting a diagnosis that is appropriate and you leave the doctors office, ER, or urgent care feeling better.
If I was a physician, I’d have this book with me all the time as a constant reminder that while systems and pathways and checklists are in place so that nothing is missed, taking the extra time to hear our your patient is just as important.
February 25, 2025
I think that there are some good points in this book. It focuses on patients being involved in their own care. As a current medical student, I was taught that you focus on open ended questions to figure out what is really going on and discuss with the patient how you want to work up what you think is going on. This book felt like it took a the examples of doctors not practicing the best medicine and projecting it onto the whole field.
Maybe this book is just outdated and that is why it was this way but not a fan and this book felt like a big waste of my time.
Maybe this book is just outdated and that is why it was this way but not a fan and this book felt like a big waste of my time.
February 24, 2019
There is valuable information in this book and I appreciated the case studies. That said, reading it felt like work at times and there was repetition. I think the tips they give for having better communication with doctors are valuable, though I was left wonder about how much practice and studying one will need to do in advance to effectively implement them.
September 26, 2019
Invaluable Advice
Of you own a body you should read this. Our medical system is inefficient and dangerous. I know many people who have lost decades of life to misdiagnosis, dangerous medications and unnecessary surgery. Understanding how this system works can save your life. Thanks to the authors, I only wish his resource had been available years ago.
Of you own a body you should read this. Our medical system is inefficient and dangerous. I know many people who have lost decades of life to misdiagnosis, dangerous medications and unnecessary surgery. Understanding how this system works can save your life. Thanks to the authors, I only wish his resource had been available years ago.
April 25, 2025
I really appreciated the core idea: careful, thorough listening underpins reasoned, proportionate response. And this book provides numerous useful tips on how to engage with your doctor. But unfortunately the writing is quite repetitive and dull overall, and fatphobia abounds. I recommend skimming this one.
October 27, 2017
This book has some very good advice for how to get the care you need from doctors who have other priorities. They provide practical tips & scripts for getting doctors on the right track & avoiding unnecessary tests.
January 14, 2019
This was a good book. Very helpful in avoiding misdiagnoses and unnecessary tests at the doctor's office or hospital. Very practical ideas. Every patient and doctor should read it. I wish I had read it before my last visit.
May 28, 2025
Only 2 main points:
1) Doctors should not use a "cookie cutter" approach for diagnosis of your symptoms
2) Need open communication with Doctor so they can do "detective work" on your symptoms and diagnosis specific to you - This will take a lot of time & patience from doctor!
1) Doctors should not use a "cookie cutter" approach for diagnosis of your symptoms
2) Need open communication with Doctor so they can do "detective work" on your symptoms and diagnosis specific to you - This will take a lot of time & patience from doctor!
March 13, 2017
Some good insights into the importance of listening to patients and trying to understand them.
November 16, 2020
Excellent
gave-up
April 20, 2021I just couldn't get through this due to vicarious anger.
April 8, 2015
This book describes medicine as an art - beginning with a brief history of medicine through various eras, leading up to the present day 'cookbook' diagnosis.* The authors, doctors themselves, do not blame other doctors for misdiagnosis, rather they fault the medical education system that is currently practiced. Basically a patient is asked a series of 'yes' or 'no' questions, which leads to a 'chief complaint', which then leads the doctor to continue down a diagnosis 'pathway' to rule out certain health conditions (the examples from the book include worse case scenarios and/or life threatening possibilities - which may be in place due to the threat of the physicians being sued). The authors believe that the art of medicine which was so prominent before, has been slowly disappearing, and has been replaced by 'cookbook' medicine.
This is an interesting read as it explains the perspectives of the patients, doctors, nurses, medical students, residents, attending physicians, triage nurses, etc. The patients offer why they felt confused by the process, how a couple of them felt stuck with no other options but to continue along the set 'pathway' and if they refused the prescribed set of tests they would have to be discharged from the hospital against medical advice which means their insurance may refuse to pay for the medical expense...so the patients are trapped by the medical system itself. The doctors also offer their perspectives, sometimes they have differing opinions about the patient diagnosis, sometimes they are influenced by recent research or recent talks such as the M&M (Mortality & Morbidity) conference.
If you only have time to skim over this book, the authors have placed little boxes with the important concepts in small notes: "+ 911 Action Tips" in each chapter.
Overall the book describes a few key takeaways for patients to be more proactive about their healthcare, which are listed in the Appendix as their pillars:
1. Tell your whole story.
2. Assert yourself in the doctor's though process.
3. Participate in your physical exam.
4. Make the differential diagnosis together.
5. Partner for the decision-making process.
6. Apply the tests rationally.
7. Use common sense to confirm the working diagnosis.
8. Integrate diagnosis into the healing process.
*This book is written specifically for patients, to assist them with giving a clear picture to their doctors for a more accurate and timely diagnosis. Also included in the Appendix is a worksheet you can fill out to better prepare yourself to give your doctor a clear picture of the symptoms you are experiencing.
This is an interesting read as it explains the perspectives of the patients, doctors, nurses, medical students, residents, attending physicians, triage nurses, etc. The patients offer why they felt confused by the process, how a couple of them felt stuck with no other options but to continue along the set 'pathway' and if they refused the prescribed set of tests they would have to be discharged from the hospital against medical advice which means their insurance may refuse to pay for the medical expense...so the patients are trapped by the medical system itself. The doctors also offer their perspectives, sometimes they have differing opinions about the patient diagnosis, sometimes they are influenced by recent research or recent talks such as the M&M (Mortality & Morbidity) conference.
If you only have time to skim over this book, the authors have placed little boxes with the important concepts in small notes: "+ 911 Action Tips" in each chapter.
Overall the book describes a few key takeaways for patients to be more proactive about their healthcare, which are listed in the Appendix as their pillars:
1. Tell your whole story.
2. Assert yourself in the doctor's though process.
3. Participate in your physical exam.
4. Make the differential diagnosis together.
5. Partner for the decision-making process.
6. Apply the tests rationally.
7. Use common sense to confirm the working diagnosis.
8. Integrate diagnosis into the healing process.
*This book is written specifically for patients, to assist them with giving a clear picture to their doctors for a more accurate and timely diagnosis. Also included in the Appendix is a worksheet you can fill out to better prepare yourself to give your doctor a clear picture of the symptoms you are experiencing.
Read
April 30, 2016A highly practical guide, including chapter summaries and worksheets, to meaningfully participating in a medical visit for an acute illness. I love the earnest advocacy for honest dialog between patients and practitioners. I agree we should all actively engage in our own care. I wonder how broadly the lessons apply, though, given cultural differences and social disparities in the U.S.? Now that Dr. Wen has experience as Baltimore Health Commissioner, how would she change the approach described in this book?
(I'm clearly influenced by reading The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures at the same time. Not to mention watching The Wire.)
(I'm clearly influenced by reading The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures at the same time. Not to mention watching The Wire.)
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