What Patients Say, What Doctors Hear by Danielle Ofri

Despite modern medicine’s infatuation with high-tech gadgetry, the single most powerful diagnostic tool is the doctor-patient conversation, which can uncover the lion’s share of illnesses. However, what patients say and what doctors hear are often two vastly different things.

Patients, anxious to convey their symptoms, feel an urgency to “make their case” to their doctors. Doctors, under pressure to be efficient, multitask while patients speak and often miss the key elements. Add in stereotypes, unconscious bias, conflicting agendas, and the fear of lawsuits and the risk of misdiagnosis and medical errors multiplies dangerously.

Though the gulf between what patients say and what doctors hear is often wide, Dr. Danielle Ofri proves that it doesn’t have to be. Through the powerfully resonant human stories that Ofri is celebrated for, she explores the high-stakes world of doctor-patient communication that we all must navigate. Reporting on the latest research studies and interviewing scholars, doctors, and patients, Ofri reveals how better communication can lead to better health for all of us.

Review:

I’m a Japanese⇔English medical interpreter so when I saw the title of Ofri’s latest book I cheered.  Doctor-patient communication – she’s talking about my life!

Medical conversations are examined from all sides.  Is it better to let a complaining patient get their whole litany out at once, or should each point be addressed as it comes up?  Can the placebo affect be utilized in conversation?  How can stereotypes be overcome?  Is it ever okay to lie to a patient?

Each topic is covered with both anecdotes based on Ofri’s patients (vignettes!) and research studies.  All kinds of strategies to improve communication are covered, from how to listen actively to when disclosing personal details is a good idea. I especially like how the studies are dissected journal club style, with weaknesses pointed out along with the strengths.  For example, one study found that doctors that scored low on an empathy test had patients with worse outcomes, but:

Maybe the low-empathy doctors had dismal hygiene and the resulting BO was too distracting for the patients to pay attention to their diabetes.  Maybe the offices of the high-empathy doctors offered cloth gowns rather than paper gowns, so their patients weren’t experiencing frostbite and thus better able to hear what the doctor was saying.  You never know what the confounding factors might be…

As an interpreter I enjoyed the stories and insight but didn’t come away with many pearls I can use myself.  It’s part of the job – I speak other people’s words and can’t outright change the direction of the conversation.  I did pick up some tips, though, particularly how using different wording can change how information is received.

What Patients Say, What Doctors Hear is a trove of information for healthcare professionals, who can expect to learn practice-changing pearls, and frequent patients will appreciate the peek into their doctor’s head. If you are not one of those two groups, though, you may want to start with a different Ofri book.

Thanks to Beacon Press and Edelweiss for providing a review copy.

Twilight Phantasies by Maggie Shayne (Wings in the Night #1)

In two centuries of living death, vampire Eric Marquand had learned to live with the cruel fate that had condemned him to walk forever in shadow, forever alone. Then he found the woman he knew was meant for him—and understood that to possess her was to destroy her.

Against all reason, Tamara Dey saw clearly that her destiny was eternally entwined with Eric’s and that she must not only accept but welcome the terror and splendor of the vampire’s kiss. She trembled at the thought of spending eternity in his arms, but was her trembling born of desire…or fear?

This book was originally published in 1993 so I was ready to give it all kids of leeway.  In the first 60% the heroine lacks agency but other lovely things are going on.  The vampire hero is the protective sort and is looking out for her.  His best vampire friend is an interesting character in his own right.  There’s an “I knew you before I met you” thing.  I’m in need of a comfort read, I was able to forgive.

But then my brain got scrambled.  Tamara gets a flat while driving home and the car doesn’t have a spare.  She is assaulted while walking to the nearest gas station, but Eric arrives in time to save her.  He then piles her into the car and drives home.

…on three tires?! I reread the scene to make sure I wasn’t missing anything and I have no idea how it worked.  Ditto her being able to put on a fancy vintage dress that laces up the back all by herself even though she needed help the first time.  Brain. Broken.

Then there’s general wtf-ery.  Tamara is 26 years old, a grown ass woman, and still lives her legal guardian.   She even says it like that.  “I can appreciate why you’re so angry with my guardian… he may be an ass, Marquand, but I love him dearly.”  Oh, and trigger warnings for assault, attempted rape, and heaps of gaslighting.  Gaaaaah.

I’m obviously not a fan… but would try another book by the author, no problem.  The first half of the book was enjoyable, even with the Old Skool issues, and I’d like to see if her more recent stuff is less objectionable.  Have you read any Maggie Shayne?  Are all of her books like this?

Passing Strange by Ellen Klages

San Francisco in 1940 is a haven for the unconventional. Tourists flock to the cities within the city: the Magic City of the World’s Fair on an island created of artifice and illusion; the forbidden city of Chinatown, a separate, alien world of exotic food and nightclubs that offer “authentic” experiences, straight from the pages of the pulps; and the twilight world of forbidden love, where outcasts from conventional society can meet.

Six women find their lives as tangled with each other’s as they are with the city they call home. They discover love and danger on the borders where magic, science, and art intersect.

Inspired by the pulps, film noir, and screwball comedy, Passing Strange is a story as unusual and complex as San Francisco itself.

Review (short version):

Guaranteed to be one of my top books of the year, if not number one.  I actually made myself put it down after a chapter or two each night so I wouldn’t finish too quickly.  Part of the joy is going in blind and I suggest you do the same, so if the blurb interests you go read it.  Now-ish. 🙂

Review (long version):

I’m going to say as much as I can while giving away as little as possible.  Characters live and breathe in a city that does the same.  The plot is wonderfully paced within an intriguing structure and the writing is as beautiful as it is unobtrusive.

Our heroines live the best life they can despite the homophobia and racism and other miasmas that hang over San Francisco in 1940.  They struggle, but they are not defined by that struggle.  They aren’t damaged or any less themselves.  These women do what they can, do what they must, and above all, persist.

I know I haven’t done the book justice so… go.  Read it.  An enthusiastic, wholehearted recommend.

Thanks to Tor and NetGalley for providing a review copy.

There are More Beautiful Things Than Beyonce by Morgan Parker

Synopsis:

There Are More Beautiful Things Than Beyoncé uses political and pop-cultural references as a framework to explore 21st century black American womanhood and its complexities: performance, depression, isolation, exoticism, racism, femininity, and politics. The poems weave between personal narrative and pop-cultural criticism, examining and confronting modern media, consumption, feminism, and Blackness. This collection explores femininity and race in the contemporary American political climate, folding in references from jazz standards, visual art, personal family history, and Hip Hop. The voice of this book is a multifarious one: writing and rewriting bodies, stories, and histories of the past, as well as uttering and bearing witness to the truth of the present, and actively probing toward a new self, an actualized self. This is a book at the intersections of mythology and sorrow, of vulnerability and posturing, of desire and disgust, of tragedy and excellence.

Review:

While I imagined myself a poet in high school (didn’t we all?) I haven’t spent much time with the form since.  Reading Why God Is a Woman reminded me that yes, poetry is awesome!  I picked up There Are More Beautiful Things Than Beyoncé to help understand an experience outside my own, that of an African-American woman today.

There are some political poems (“The President Has Never Said the Word Black“) but the thrust of the work is rooted in pop culture, especially music.  The Beyoncé poems are especially wonderful – here’s the beginning of “Beyoncé On The Line for Gaga”:

Girl you know you ain’t that busy.
Without me            you’re just two earsstuffed with glitter.

Parker manages to be funny and skewering at the same time.  In “Afro” she lists what she’s hiding in her hair, including “buttermilk pancake cardboard… 40 yards of cheap wax prints… blueprints for building ergonomically perfect dancers & athletes”.  And when Parker goes for the jugular she doesn’t miss, like in the first lines of “The Gospel According to Her”:

What to a slave is the fourth of july.
What to a woman is a vote.

Being newly returned to the world of poetry there are some pieces I had a hard time wrapping my mind around.  Maybe it’s a lack or perspective or the wrong mindset, maybe I’m just out of practice.  So if you’re looking for instant clarity you may be disappointed but I’m sure these poems will gain meaning the more time I spend with them.  Good stuff.

Thanks to Tin House Books and Edelweiss for providing a review copy.

For Real by Alexis Hall

Laurence Dalziel is worn down and washed up, and for him, the BDSM scene is all played out. Six years on from his last relationship, he’s pushing forty and tired of going through the motions of submission.

Then he meets Toby Finch. Nineteen years old. Fearless, fierce, and vulnerable. Everything Laurie can’t remember being.

Toby doesn’t know who he wants to be or what he wants to do. But he knows, with all the certainty of youth, that he wants Laurie. He wants him on his knees. He wants to make him hurt, he wants to make him beg, he wants to make him fall in love.

The problem is, while Laurie will surrender his body, he won’t surrender his heart. Because Toby is too young, too intense, too easy to hurt. And what they have—no matter how right it feels—can’t last. It can’t mean anything.

It can’t be real.

Gaaaaah this book is wonderful and I’m thrilled to see it won a RITA for its awesomeness.

The good:

• I love flipped tropes and this one is particularly delicious.  While most BDSM romances have a hunky alpha dom here Laurie, the sub, is the one with age and muscles on his side.  Toby is young, scrawny, and inexperienced so no one takes him seriously as a dominant but he convinces Laurie to give him a shot.
• Similarly, it’s refreshing to have being penetrated separated from being the sub.  Universe – more of this, please!
• The characters are masterfully drawn and realized.  They are flawed but it’s subtle, no unnecessary “oooo I wonder what his awful secret is!” angst.  We learn more about the heroes as the story goes on and each detail reinforces what we already know.
• The large age difference is addressed and dealt with well.  It ends up being the largest sticking point of the relationship which rings true for me.
• Chapters are told from each hero’s perspective and they could not be more different.  Laurie sound like the older, educated gentleman that he is, and Toby’s point of view is more casual and slang-filled.  The difference carries over into their speech so the whole book feels more unified than I was expecting with different POVs.
• Laurie is a doctor and my (partially trained) eye didn’t find any medical weirdness or errors.  This is more rare than you would think.
• The story is plain ol’ good.  I loved watching the couple fall in love and swallowed chapters in greedy gulps.

The only not-so-good things I can think of are nitpicks and not even worth mentioning.  If you like BDSM romance, or gay romance, or just plain ol’ romance For Real is a wonderful read.

Rogue Magic by Kit Brisby

While trapped in a stalled subway train on his morning commute, PR rep Byron Cole flirts with Levi, a young waiter with adorable curls. But Byron’s hopes for romance crash and burn when Levi saves him from a brutal explosion—with outlawed magic.

When Levi is imprisoned, Byron begins to question everything he’s ever believed. How can magic be evil when Levi used it to save dozens of lives? So Byron hatches a plan to save Levi that will cost him his job and probably his life. If he doesn’t pull it off, Levi will be put to death.

Byron must convince Levi to trust him, to trust his own magic, and to fight against the hatred that’s forced him to hide his true nature his entire life. The more Levi opens up, the harder Byron falls. And the more they have to lose.

Ooo boy, is this book timely.  In a world very much like our own magic is a real thing.  Not everyone can use it, and those who can are forced to register with the government and are vilified by the public.  (See that? Yup.)

Bryon works for the company that confines mages and believes the party line until he meets Levi, who saves his life with a well placed magical shield.  Bryon wrapping his brain around this new information is one of my favorite parts of the book.  We watch him struggle with long held beliefs, do his best to open his mind, and become friends with people he formerly would have brushed aside.  The process takes time and feels right.

Brisby’s New York is delightfully rooted in the reality of our own, and I appreciate that the medical details are (to my knowledge) accurate.  The friendships are especially satisfying, maybe even more than the insta-romance that pops up.

The world building is good early on but, like the plot, it loses steam. I would have liked more info about the history of mage suppression or theories on where the magic comes from and why only some people can use it. A lot gets swept under the rug with ‘it’s outlawed, so we don’t know’ which works in the beginning but gets frustrating as the story goes on. In a similar vein the ending left me with some unanswered questions as well as doubts that everything could have changed so quickly.  And if you like your allegory subtle this is anything but.

Still, I enjoyed Rogue Magic.  A diverse, escapist urban fantasy that manages to both address and take my mind off of current events?  I’m here for that.

Thanks to Riptide Publishing and NetGalley for providing a review copy.

The Egg and I by Betty MacDonald

When Betty MacDonald married a marine and moved to a small chicken farm on the Olympic Peninsula in Washington State, she was largely unprepared for the rigors of life in the wild. With no running water, no electricity, a house in need of constant repair, and days that ran from four in the morning to nine at night, the MacDonalds had barely a moment to put their feet up and relax. And then came the children. Yet through every trial and pitfall—through chaos and catastrophe—this indomitable family somehow, mercifully, never lost its sense of humor.

A beloved literary treasure for more than half a century, Betty MacDonald’s The Egg and I is a heartwarming and uproarious account of adventure and survival on an American frontier.

Review:

I was excited to find that the author of the Mrs. Piggle Wiggle books wrote a memoir about chicken farming in the Pacific Midwest, complete with “The Enduring Classic” blazed on the cover.  But this doesn’t feel like a classic at all, with MacDonald’s sharp wit aimed at people who least deserve the jabs.

She moved to the wilds of Washington with her husband, determined to be the best wife she can by doing whatever makes her husband happy, no questions asked.  Let’s count that as Anger Runneth Over #1 – woman with zero agency.  She hates the chicken farming her husband loves and seems to find no joy in life on the mountain. Sometimes the barbs are funny and telling of how awful she found things.

In my little Death and Food Record book, I, in my prankish way, wrote opposite the date and number of deaths; “Chickenpox-Eggzema and Suicide.” When he checked the records, Bob noted this fun-in-our-work, and unsmiling erased it and neatly wrote, “Not determined.” Men are quite humorless about their own business.

But these moments are few and far between. More often MacDonald lights into her neighbors and people in town, judging them by her city standards of culture and erudition.  Whole passages are written phonetically to exaggerate their manner of speaking and, apparently, the humor.

Charlie wath butchering and I athk him for the thpare ribth becauthe they kilt two pigth and I knowed that the two of them couldn’t eat all them thpare ribth, but that thtingy thkunk thaid, “The reathon I’M BUTCHERING, MR. KETTLE, is becauthe I need the meat,” and I wath tho mad I forgot the egg math I had borried.

Instead of poking fun at a situation she’s grinding people into the dirt, holding them at fault for being different or not being given the same opportunities she has enjoyed.  This closed mindedness and snobbery is Anger Runneth Over #2.

It’s not that MacDonald is incapable of nuance – if she gave other people the consideration she reserved for her grandmother the book would be much more readable.

Gammy was patient, impatient, kind, caustic, witty, sad, wise, foolish, superstitious, religious, prejudiced, and dear.  She was, in short, a grandmother who is, after all, a woman whose inconsistencies have sharpened with use.

Instead we run into Anger Runneth #3, her view and treatment of the Native Americans of the area.  I went into the book knowing that racism of this sort would be an issue and prepared to see the book as of its time, but it’s hateful and awful even for the 1940s.

Little red brothers or not, I didn’t like Indians, and the more I saw of them the more I thought what an excellent thing it was to take that beautiful country away from them.

It hurts me so much to even type that.

There are a couple of chapters that are funny if separated from all the rage-inducing passages but I doubt it’s worth the effort.  Consider The Egg and I a classic you can safely skip.

The Phantom Lover by Elizabeth Mansfield

Fiery young “Nell” Belden went to Thorndene Castle to escape a lover, not to find one. She was bound by the strict conventions of England’s Regency to a man she could never love, then bound by the ties of passion to a man she could never marry! For at Thorndene, she discovered a new and startling love, a love that was as intense as it was doomed…

“You must leave Thorndene!” said the ghost. Then he added, more gently, “I come to warn you, not to harm you. I may never touch you, any more than a shadow may..”

“What does that signify?” Nell asked. “Since you are dead, you can have no need or inclination to touch me anyway.”

“You can’t know much about men-or ghosts-or how delightful you look in that nightdress, if you believe that,” he said with disturbing sincerity.

Nell blushed and pulled the bedclothes over her. For a long moment, neither of them spoke. Then, as suddenly as it had appeared, the ghostly figure was gone…

Review:

After seeing the 1979 publication date I was afraid this book would be full of literal bodice ripping and alpha-holes and old skool awfulness.  But in fact it’s a lovely Regency romance with a feminist heroine and a good share of laughs.

The good:

• Nell is a strong character that has her head on straight.  She calls people out on their bullshit and is determined to only marry for love.
• The hero appearing as a “ghost” is fun device that is executed well.  There’s nothing domineering about Henry, a genuinely nice guy.
• While there’s a ballroom scene most of the action takes place away from society, allowing for a comfortingly small cast of characters.  Everyone is fleshed out, from the housekeeper’s family to the suitor from hell.
• The whole book is just silly in a good way.  Great aunt (or is it grandma?) Amelia is always good for a laugh and the action never gets too heavy or dour.  Escapist romance for the win!

The not-so-good:

• The relationship between the hero and heroine’s families is a little convoluted and I’m still not sure I can explain it.
• The ending is rushed and only half-earned.

All in all a welcome diversion that reads quickly and leaves you smiling.