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When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests Paperback – June 24, 2014

4.4 out of 5 stars 103 customer reviews

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Editorial Reviews

From Booklist

All doctors are taught the art (and value) of obtaining a thorough medical history from their patients. An estimated 90 percent of diagnoses can be made from the history of illness alone. Increasingly, though, many doctors are paying less attention to these stories of sickness. Algorithms and clinical pathways, time constraints, fear of misdiagnosing a serious illness, and an increased reliance on technology have often relegated conversations between physicians and patients into brief interrogations. Physician-authors Wen and Kosowsky utilize true tales of patients treated in the emergency room to illustrate “how medicine has morphed from thoughtful engagement between doctors and patients to cookie-cutter recipes that regard all individuals alike.” The authors argue that such a cookbook methodology can be hazardous. They recommend “an individualized, patient-centered approach to diagnosis” that enhances patient comprehension, lowers the chance of malpractice lawsuits, and cuts down on the excessive use of tests such as CT scans. Sound suggestions for improving diagnosis abound. For patients, become more active participants in the process. For physicians, take time and listen. --Tony Miksanek --This text refers to the Hardcover edition.

Review

“The book's insights and cautionary tales should appeal to medical and lay readers alike: they combine into a superb analysis of how doctors listen and think, and offer detailed suggestions for how they could do both better.” ―The New York Times

“Leana Wen and Joshua Kosowsky, emergency physicians at Brigham and Women's Hospital in Boston and Harvard University, urge patients to assert their voice. They warn that ‘a health care crisis is not the time to keep your mouth shut,' but rather a critical time to speak up and be your own advocate.” ―The Wall Street Journal

“Wen and Kosowsky demystify medical language and practice and offer straightforward tips.” ―Concord Monitor

“A comprehensive guide to improving doctor-patient relations through empowering patients to take an active role in their care. . .As health care becomes more complex and political, this book provides clear direction toward better care.” ―Kirkus Reviews

“Doctors Wen and Kosowsky (Pocket Emergency Medicine, co-editor) nudge the medical "consumer empowerment movement" forward with this provocative dialogic guide to help patients get the right diagnosis and treatment while avoiding the pitfalls of formulaic "cookbook" medicine. It all starts with an open conversation, the pair assert--much like the banter between car owner and mechanic on NPR's popular Car Talk program--and ends with an active M.D.-patient partnership. "You are the key to your own health, and you have to help your doctor help you," the duo insist. Recounted are hair-raising stories of patients who bore the brunt of doctors leaping to "worst-case reasoning" instead of listening to what their patients were telling them, like Jerry the car mechanic with a pulled muscle who was treated for a heart attack. The team warns consumers that the transformation from passive recipient of medical care to active partner won't be easy, but provide plenty of how-tos in their "8 Pillars" toward building a patient-doctor partnership. Theirs is an urgent call to action for patients, and a stark heads-up for doctors and the troubled healthcare industry they serve.” ―Publishers Weekly

“Wen and Kosowsky's work is significant... Who should read When Doctors Don't Listen? Wishfully, doctors...certainly psychologists, and social workers...mental health providers... [and] anyone who is now or anticipates following family members of loved ones through illness and anyone who is concerned about his or her own medical care.” ―PsycCRITIQUES

“This is a well-written book on an innovative approach to healthcare reform: it challenges patients to take charge of their health and every medical encounter with their doctor. An important topic and an important book--I encourage my patients to read it.” ―Siddhartha Mukherjee, Pulitzer Prize-winning author of The Emperor of All Maladies: A Biography of Cancer

“I have always said that a hospital can kill you as sure as cure you. You must be your own best advocate. Follow the advice of Drs. Wen and Kosowsky…and transform from being a patient to an advocate for your own health.” ―Fran Drescher, actor, producer, activist, and author of Cancer Schmancer

“It's critical for patients to advocate for their own health. This book teaches you how…Read it; it will change radically how you approach your doctors.” ―Melissa Etheridge, Grammy Award-winning musician and host of The Melissa Etheridge Radio Show

“This clearly-written, brilliantly and creatively thought-out book, filled with fascinating and horrifying examples of how doctors are now trained to not listen to their patients in order to ‘rule out' diseases, focuses on ‘ruling in' diagnoses that not only are accurate, but that will save billions of dollars per year in lawsuit-driven tests. A brave, terrific, essential work.” ―Samuel Shem, M.D., Ph.D., author of The House of God and The Spirit of the Place

“Leana Wen and Josh Kosowsky have written an authoritative guide to answer a seemingly simple question: How should you talk to your doctor? Through fascinating examples taken from their own clinical experiences, they show how doctors' training fails to teach real listening skills. But Drs. Wen and Kosowsky don't stop there: They also offer up constructive and practical advice that just might save your life.” ―Darshak Sanghavi, MD, Chief of Pediatric Cardiology, University of Massachusetts Medical School, health care columnist for Slate, contributing editor at Parents magazine, and author of A Map of the Child: A Pediatrician's Tour of the Body

“Their proposal for ‘diagnostic partnership' is a major contribution of this courageous book in which common sense plays the leading role.” ―Julio Frenk, MD, PhD, Dean of the Harvard School of Public Health

“A powerful appeal for individualized medical evaluation based on an active partnership between doctors and patients. The rational, mutual approach to diagnosis advocated by Drs. Wen and Kosowsky is the antidote for mindless and wasteful routines that all too often replace careful listening and focused assessment of each patient.” ―Harvey V. Fineberg, M.D., Ph.D., President, Institute of Medicine

“Exposes the stereotypic physician following cookbook recipes to liberating a new frontier in the ‘art' of humanistic medicine that empowers patients and physicians alike.” ―Lincoln Chen, MD, Director, Global Equity Center at Harvard Kennedy School of Government

“Not only offers a compelling argument for revitalizing this touchstone of good medicine, but also provides a comprehensive guide for how doctors and patients can improve the quality of healthcare by doing so.” ―Jordan J. Cohen, MD, Professor of Medicine and Public Health, George Washington University, and President Emeritus, Association of American Medical Colleges

“This is an important contribution to helping both physicians and patients more effectively manage their encounters. The authors make it clear that ‘more medical care' may frequently be harmful to a patient's health.” ―Robert Graham, MD, Professor of Family and Community Medicine, University of Cincinnati

“This book is a must read for informing the dialogue about health care reform and transforming medical education. Its humanistic authors provide support for re-integrating the lost art of humanism with more scientific medicine. The authors' passion for the individual behind the illness is contagious.” ―Afaf I. Meleis, Ph.D., DrPS (hon), FAAN, Margaret Bond Simon Dean of Nursing, University of Pennsylvania

“Doctors take an oath to do no harm. Yet more than ever, modern medicine makes healthy people sick. Emergency physicians Leana Wen and Josh Kosowski make a passionate argument for patients to get involved and informed about their care. A fast, smart read to help you take charge of your health.” ―Audrey Young Crissman, MD, author of What My Patients Taught Me: A Medical Student's Journey

“Evidenced based medicine, clinical guidelines, and diagnostic algorithms have been widely adopted as an answer to inconsistent and out-of-date medical practice. Drs. Leana Wen and Joshua Kosowsky make the case that the resultant algorithms-gone-wild syndrome seen in many medical settings today actually drives imprecise and wasteful testing, muddled diagnoses, and patient confusion. They argue that these clinical behaviors are at the heart of our "morbidly obese" medical care system and that thoughtful physicians relying on patient narratives and diagnostic common sense will create a leaner medical care system and better patient outcomes. Theirs is a contrarian and compelling case with the wellbeing of millions of patients and $250 billion a year riding on it.” ―Fitzhugh Mullan, MD, Murdock Head Professor of Medicine and Health Policy, The George Washington University

When Doctors Don't Listen by Drs.Wen and Kosowsky have insightfully crafted a revelation about the workings of modern medicine. It addresses with a finely nuanced balance the basis for our dysfunctional "cookbook style" of medicine. The analysis is not a critical pontification by outsiders, but a pained view by deeply informed insiders. The book pleads powerfully for the disenfranchised patient. It must be read both because most of us sooner or later are bound to seek health care and because the authors provide an important viewpoint for the intensifying nationwide health care debate.” ―Bernard Lown, MD, Professor emeritus Harvard School of Public Health, Senior Physician emeritus Brigham and Women's Hospital, Nobel Peace Laureate 1985

“What a brilliant concept – this outstanding book provides an innovative and interesting approach to understanding how physicians interact with patients presenting with an illness and reach a diagnosis. Using a case-based approach followed with careful analysis of the process by two experts in the field of Emergency Medicine, clarity and transparency are provided to one of the most complex areas of medicine, how the physician develops the framework for a diagnosis and orders tests to prove it. Drs. Wen and Kosowsky have given the non-medically trained reader a variety of common scenarios for presentation to the Emergency Department. Physicians often reach a wrong diagnosis by following set pathways hard-wired from years of training and experience. Unfortunately, key words or phrases from the patient which lead the physician down a "typical" pathway for an illness can trigger the wrong answer and result in a large number of expensive, time-consuming, and potentially harmful tests. By teaching the patient the importance of providing the essential information on their illness to the physician, and making sure the physician actually listens to them, the likelihood that the physician makes the correct diagnosis increases substantially. This excellent book contains a literal treasure trove of information which will be beneficial and educational for patient and physician alike. As popular as the ED has been over the last two decades, pictured in television shows such as "ER" and other medically oriented television series, I anticipate this book will be widely read, very successful, and often quoted, not only by the lay public but also the medically-trained care providers who strive to listen better to their patients.” ―W. Brian Gibler, MD FACEP, FACC, President and CEO, University Hospital, Senior Vice President, UC Health, Professor of Emergency Medicine, University of Cincinnati College of Medicine

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Product Details

  • Paperback: 352 pages
  • Publisher: St. Martin's Griffin; Reprint edition (June 24, 2014)
  • Language: English
  • ISBN-10: 1250048486
  • ISBN-13: 978-1250048486
  • Product Dimensions: 5.5 x 0.9 x 8.2 inches
  • Shipping Weight: 10.4 ounces (View shipping rates and policies)
  • Average Customer Review: 4.4 out of 5 stars  See all reviews (103 customer reviews)
  • Amazon Best Sellers Rank: #331,860 in Books (See Top 100 in Books)

Customer Reviews

Top Customer Reviews

Format: Hardcover
This is, first and foremost, a book for patients and the lay public. In the opening chapters, the book uses real patient stories to illustrate the problems of so-called "cookbook medicine" - the idea that patient encounters can be simplified into a single complaint that can be worked up using a defined, inflexible clinical pathway. As a doctor working in an emergency department, I have definitely seen this type of medicine practiced and completely agree with the authors that it contributes to over-testing, robotic diagnosis, escalating health care costs, and patient disempowerment.

In subsequent chapters, the authors provide a comprehensive list of concrete tips to avoid the pitfalls of cookbook medicine, emphasizing that the key is creating a respectful, equal partnership with doctors. The authors argue that all people can optimize their health care interactions by taking a more active role in their care, regardless of the quality or personality of their doctor. One particular strength of the book is that it helps readers learn how to communicate with doctors by discussing medical training, medical lingo, and how doctors make diagnoses. In the same way that it helps to know a little about cars and car mechanics before going to a garage, it helps to know a little about medicine and medical providers before seeking care.

In short, this is a book that I would recommend to anyone looking to become a more effective user of the health care system. While medical providers might find parts of this book a little basic, I would also recommend the book to them because it challenges many aspects of conventional practice and highlights the paramount importance of the medical history. I found myself re-evaluating my patient communication style after reading this book, and I think that many other providers will do the same.
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Format: Hardcover
The authors (E.R. physicians and Brigham and Women's hospital in Boston), contend that today's practice of medicine has morphed into a cookbook 'pathways' approach that leads to less accurate diagnoses, worse outcomes for patients, and contributed to ballooning costs. Excessive testing is estimated to contribute 10% to the cost of health care, as well as unneeded worry and sometimes useless/harmful treatment. Their point, however, is not to do away with all attempts to standardize care (eg. Atul Gawande's simple rules to prevent infections in ICUs and ORs are an invaluable contribution), but to modify them as appropriate for the patient.

The authors draw upon their own experiences to present their case. Their first example involved a patient (Mary) with stomach pain, vomiting, and diarrhea. She went to the E.R. - blood work and a CT scan were called for. While waiting for the result she started feeling better, but they told her the CT scan was abnormal and a more specialized scan was needed, 120 miles away in Boston. The second CT told them she was fine - probably just a viral illness. Drs. Wen and Kosowsky contend this would have been avoided if her original caregivers had really listened to how her symptom's started. They add that part of the problem is that it's now become so easy to order eg. a CT; thus, doctors will do so 'because I want to be sure I don't miss anything' and many doctors have stopped thinking about what they're being used for.

Many physicians contend that cutting down on tests risks medical liability suits. In response, the authors believe that the biggest problem, per patients who have sued, is some version of 'the doctor didn't take the time to listen to me,' or 'didn't tell me what all the tests were about.
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Format: Kindle Edition Verified Purchase
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.
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