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When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests Hardcover – January 15, 2013
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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
“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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The responsibility for our health care is ours individually, and doctors are simply resources and tools that are available to us in the pursuit of good health. Unfortunately, although some health practitioners function in a way that is designed to help the patient, there are more and more doctors who simply do not listen - DO NOT LISTEN - to the patient, and spend their precious time talking "at" rather than with the patient, gathering partial data, failing to understand the problems we come to have them solve before prematurely arriving at a diagnosis, and too often those diagnoses are, at best, incomplete, if not altogether incorrect - because they DO NOT LISTEN.
Buy this book. Read it. Use it. It can help.
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I've had some less than pleasant experiences with physicians, who quite frankly, were imperfect...Read more