The Laws of Medicine by Siddhartha Mukherjee

25409816Over a decade ago, when Siddhartha Mukherjee was a young, exhausted, and isolated medical resident, he discovered a book that would forever change the way he understood the medical profession. The book, The Youngest Science, forced Dr. Mukherjee to ask himself an urgent, fundamental question: Is medicine a “science”? Sciences must have laws—statements of truth based on repeated experiments that describe some universal attribute of nature. But does medicine have laws like other sciences?

Dr. Mukherjee has spent his career pondering this question—a question that would ultimately produce some of most serious thinking he would do around the tenets of his discipline—culminating in The Laws of Medicine. In this important treatise, he investigates the most perplexing and illuminating cases of his career that ultimately led him to identify the three key principles that govern medicine.

Review:

I’ve been meaning to read Mukherjee for a while now, especially considering how highly regarded Emperor of all Maladies is. That tome is 571 pages, though, so I thought The Laws of Medicine would be a better introduction.

And straight off I can tell you that I like his writing and his style.  He neither dumbs down examples nor overexplains details.  I want to read more… especially because this book is so short.

Clocking in at under 100 pages, it introduces the three laws of medicine Mukherjee devised.  One is more aimed at research than clinical practice, and one is dead obvious to anyone who has studied medicine (even this lowly interpreter) but they’re still good points and worthy of the attention.

What hurts the most for me is that book could have been longer.  The idea of laws could be better explored, corollaries proposed and debated, and exceptions that prove the rule gone over.  As it stands the information is sufficient but not satisfying.

I listened to the audiobook and like the reader and the way it is produced.  Having the author read the introduction is always a nice touch.

While I liked The Laws of Medicine it didn’t affect me as much as What Doctors Feel and other medical non-fiction does.  But that’s okay – I’m viewing it as a tantalizing preview of Mukherjee’s longer, more in-depth work.  Onward!

What Patients Say, What Doctors Hear by Danielle Ofri

32820244Despite 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.

Foundations of Clinical Psychiatry edited by Sidney Bloch et al.

preview_bloch-final-cover_fcFoundations of Clinical Psychiatry is the trusted introductory text for students of medicine and other health professions, including psychiatric nursing, psychology, social work and occupational therapy. It has also been the essential reference for family doctors for over quarter of a century.

The four-part structure—an introduction to clinical psychiatry; conditions encountered; specific patient groups and clinical settings; and principles and details of typical clinical services, and of biological and psychological treatments—provides a clear overview of clinical practice. It also explores the causes of mental illness and the ethical aspects of its treatment, and covers the full range of psychiatric disorders encountered by health practitioners.

Review:

Yes, this is a medical textbook.  But don’t run away just yet!  If you work in any kind of health profession or have contact with people with mental illness you will find it invaluable.

For background I’m a medical interpreter. If you speak English and walk into a Japanese hospital while I’m on shift I’ll help you communicate with doctors and staff across languages to make sure you receive the best care.  I love my job – I never know what kind of patients I’ll meet on a particular day.  I’ve seen everything from heart attacks to common colds but being called to psychiatry always gives me pause.  Does someone need their medication adjusted?  Will I be interpreting a psychotic delusion?  Or is the patient thinking of killing themselves and in need of immediate help?

After reading this book I feel much more prepared for whatever may come my way.  The book is split into four parts – An Approach to Clinical Practice covers the history, classification, and ethics of psychiatry. The Range of Psychiatric Disorders covers each disorder in detail while the next section, Special Clinical Areas, highlights areas like forensic psychiatry and women’s mental health.  Last is a detailed section on the different treatment options available.  It’s a thorough approach that’s aimed squarely at people with medical know-how who aren’t necessarily doctors themselves.

I highlighted so. many. passages!  I plowed straight through but the chapters stand alone so you can read what interests or affects you.  If you work in a nursing home you’ll gravitate towards psychiatry of old age and neuropsychiatric disorders (like dementia and Alzheimer’s), and if you’re an interpreter like me the chapter on psychiatric interviews will be pure gold.

Foundations is from an Australian publisher but they use both American (DSM-5) and international (ICD-10) classifications.  I now have a deeper, better understanding of all the little corners of psychiatry and have some insight into what the doctor is thinking or aiming for during a particular consultation.

Will everyone be excited to read about mental illness?  I’m going to guess not.  ;)  But if you work in a medical environment or with people affected by psychiatric disorders you’ll learn a ton and be more prepared for whomever may walk through the door. So consider this a hearty, if narrow, recommend.

Thanks to Melbourne University Press and NetGalley for providing a review copy.

Committed by Dinah Miller and Annette Hanson

Synopsis:

29955558Psychiatrists Dinah Miller and Annette Hanson offer a thought-provoking and engaging account of the controversy surrounding involuntary psychiatric care in the United States. They bring the issue to life with first-hand accounts from patients, clinicians, advocates, and opponents. Looking at practices such as seclusion and restraint, involuntary medication, and involuntary electroconvulsive therapy–all within the context of civil rights–Miller and Hanson illuminate the personal consequences of these controversial practices through voices of people who have been helped by the treatment they had as well as those who have been traumatized by it.

The authors explore the question of whether involuntary treatment has a role in preventing violence, suicide, and mass murder. They delve into the controversial use of court-ordered outpatient treatment at its best and at its worst. Finally, they examine innovative solutions–mental health court, crisis intervention training, and pretrial diversion–that are intended to expand access to care while diverting people who have serious mental illness out of the cycle of repeated hospitalization and incarceration. They also assess what psychiatry knows about the prediction of violence and the limitations of laws designed to protect the public.

Review:

Involuntary care is a a minefield of ethical conundrums.  How do you decide who needs treatment?  What if the patient calmly refuses it?  Will the treatment itself be more traumatizing than beneficial?  How can you ethically hold people against their will?  And when is it okay to let them go?

Miller and Hanson cover as many points of view as humanly possible, from pro-involuntary treatment groups like the National Alliance on Mental Illness to anti-anything-psychiatry groups like Scientology.  (Yes, they managed to interview a Scientologist for this book.  It’s kind of amazing.)  There are all kinds of opinions between the extremes that are also covered – those who would rather see outpatient commitment instead of inpatient, for example, and people who want to help patients recover with or without medication.  They also speak with professionals that are involved in the civil commitment process, from judges and lawyers to police officers and ER doctors.

There is a ton of information but it never gets overwhelming.  The narrative is loosely hung on the cases of two patients, one who had a positive experience with involuntary care and one who was traumatized by her time at the hospital.  Though interviews with these patients, their families and doctors, and peeks at their medical charts, we see how forced care could be the best or worst thing to happen to someone.  Their journey is covered from being picked up by police or brought in by a family member, through civil commitment trials and treatment, to how they were determined to be fit for release.

Laws widely vary across the United States and their differences are an illustrative example of what policies seem to work and which should be rethought. As a result Committed gives you a framework of possibilities that you can use to examine the laws that affect you, no matter where you live.

The thing that strikes me most about this book is the care and consideration that went into it.  Miller and Hanson, psychiatrists, never deride anyone for their views. They sat across the table from people who think their profession is basically evil and held a civil, thoughtful conversation. If there’s an outrageous factual error they’ll mention it in passing with research to back them up, but otherwise everyone is allowed to say their piece exactly as they’d like in a non-confrontational environment. Mad props.

They’re also forthcoming about the circumstances surrounding their reporting.  Getting an inpatient unit to agree to Miller observing was harder than they thought, and they are upfront with the fact that the only hospital that would agree has one of the best psychiatric departments in the country.  And try as they might they couldn’t get anyone to talk about guns and mental illness on the record.

Doctors, [the gun club representative] noted, are seen by gun owners as an extension of the government. …people were happy to engage in casual conversation, but before they would speak in depth, they wanted reassurance that we were not in favor of gun control, regardless of whether that was relevant to the topic of the book.

Any time I thought there might be a hole in the reporting or an odd circumstance it was covered in this thorough, thoughtful manner. The authors have earned all of my respect.

Committed is a must read for anyone whose job brings them in contact with people with psychiatric illness as well as anyone with an interest in civil rights.  And if you’re curious about how mental hospitals work (aren’t we all?) it’s a fascinating look at this “hidden world, open only to those who are in enough despair to gain admittance”.

Thanks to Johns Hopkins University Press and Edelweiss for providing a review copy.


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Working Stiff by Judy Melinek and T.J. Mitchell

Synopsis:

19967171Just two months before the September 11 terrorist attacks, Dr. Judy Melinek began her training as a New York City forensic pathologist. With her husband T.J. and their toddler Daniel holding down the home front, Judy threw herself into the fascinating world of death investigation—performing autopsies, investigating death scenes, counseling grieving relatives. Working Stiff chronicles Judy’s two years of training, taking readers behind the police tape of some of the most harrowing deaths in the Big Apple, including a firsthand account of the events of September 11, the subsequent anthrax bio-terrorism attack, and the disastrous crash of American Airlines flight 587.

Lively, action-packed, and loaded with mordant wit, Working Stiff offers a firsthand account of daily life in one of America’s most arduous professions, and the unexpected challenges of shuttling between the domains of the living and the dead. The body never lies—and through the murders, accidents, and suicides that land on her table, Dr. Melinek lays bare the truth behind the glamorized depictions of autopsy work on shows like CSI and Law & Order to reveal the secret story of the real morgue.

Review:

My favorite part of Law and Order is when the detectives visit the morgue.  “See these marks around the neck?”, the medical examiner asks.

“Yeah,” the grizzly cop says, “from hanging himself.”

“If he hung himself they’d go upwards behind the ears, but these marks go straight back.  He was strangled.”

Stunned silence.

“You’ve got yourself a homicide.”

I love that!  The courtrooms and stuff are good too, but the medical evidence is where it’s at.  If you agree you’ll love Working Stiff.

Melinek goes through her training and most memorable cases as a medical examiner in New York City.  She started her career as a surgeon but found 130 hour work weeks unsustainable (luckily there are limits on that now), and forensic pathology was a way to keep her scalpel and do good.

“There are no emergency autopsies,” another resident pointed out to me.  “Your patients never complain.  They don’t page you during dinner.  And they’ll still be dead tomorrow.”

Cutting open dead bodies is by definition gruesome but the gore is never played up for gore’s sake.  A medical examiner has to master both the medical/legal language surrounding death and common sense explanations to use with families, and Melinek does a great job keeping everything intelligible.

I wrote the cause of death as “anoxic encephalopathy due to loss of consciousness of undetermined etiology.”  This translates as “lack of oxygen to the brain from fuck-if-I-know.”

That being said if you already know your spleen from your pancreas you’ll feel even more at home.

The stories progress from training through routine autopsies, homicides, and finally the teased terrorist attacks and plane crash.  It’s not linear but the order eases the reader into forensics, showing how each situation is handled.  And there’s so much cool stuff!  Injuries that only show up after a day has passed, how to figure out which stab wound came first, pinning down someone’s age thanks to a single rib bone.

Melinek co-wrote this book with her husband and you do get the feel that there are two hands at work, with Melinek writing up the cases and Mitchell adding the connective tissue that hold them together.  It was never enough to take me out of the story, but it was there.  And fair warning – she talks about her father’s suicide at length, so beware if that’s something you’d rather not read.

A wonderful read for medical geeks and anyone who perks up when Law and Order heads to the morgue.

Tell Me Exactly What Happened by Caroline Burau

Synopsis:

9781681340098_892e2In her new book, veteran 911 operator Caroline Burau shares her on- the- job experiences at both a single- person call center (complicated by a public walk- up window) and a ground and air ambulance service. Whatever the position, the challenges for a dispatcher never end. Tragedy, boredom, and mind- bending weirdness are constant companions, as her stories- some funny, some odd, some sad- show. A “broken penis,” a case of domestic violence at the walk- up window, a tornado striking a mile away- Caroline Burau handles them all with efficiency, empathy, and humor.

But the job is not an easy one. On top of dealing with life-and-death situations everyday, Burau is shaken by the suicide of a colleague. She battles stress and burnout, knowing that she is truly helping people. She also realizes that no matter how long she is in the hot seat, listening, waiting, and answering 911, she cannot help everyone. Tell Me Exactly What Happened is one woman’s memoir, but it is also a welcome companion for anyone who has needed relief from a stressful job.

Review:

Your job can warp you.  My father was an electrician and is quick to analyze the lighting set up in any restaurant.  I was a tour guide in college and can still walk backwards like a pro. (It’s a great way to freak out a group of friends.)

Imagine being a 911 operator and listening to people have the worst day of their lives, every day.

When [Stella] was in her first year, she took a call of a five-year-old girl choking on a grape. “It was book perfect,” she said, meaning the response was right on.  She acted quickly, her responders were on the scene within minutes, and the patient was whisked to the local ER in record time.  Yet she died anyway.  So until the day her only child went off to college, Stella never let Tristan eat a single grape without first cutting it in half.

Not every call is life and death.  There’s people wondering about power outages, noise complaints, and every brand of wtf-ery you could imagine.  Burau puts snippets of exchanges between chapters to give you a feel for the kinds of people that call.

“Sir, is your friend completely alert?”
“No, but I mean, he’s not the brightest guy normally, anyway.”

It’s a harrowing and interesting job, yet removed from most of the actual life saving.  There is only so much you can do on the other end of a phone line, and this book does a good job showing exactly what it’s like to sit at the console, warts and all.

The writing is basic but mostly effective.  I would have liked the through-line and themes to have been tied together more but it works well enough.  What bothered me the most are the times Burau heedlessly runs head first towards something without thinking about the consequences.  She agrees to go on a national talk show but she’s never watched an episode. This fact is mentioned early and is meant as foreshadowing, I think, but it made me put down the book for a while.  “No way is this going to go well.”  And it didn’t.  Not horrific, but still.  I didn’t care for the dread.

I’m sure the author had no control over the cover but it still bothers me – she works at a call center, not in scrubs.  And no one uses those paddles any more, they have thin pads they stick on you instead.  Burau does spend a lot of time talking people through medical emergencies but it feels a bit dishonest.

If you’re in a medical or medically-adjacent field you’ll appreciate this insight into a dispatcher’s work.  If you’re a dispatcher yourself you’ll enjoy hearing from a sister in arms.  I won’t be pressing this book into everyone’s hands, though.

Thanks to Minnesota Historical Society Press and Edelweiss for providing a review copy.


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Shrink Rap by Dinah Miller, Annette Hanson, and Steven Roy Daviss

Synopsis:

9827786Finally, a book that explains everything you ever wanted to know about psychiatry!

Based on the authors’ hugely popular blog and podcast series, this book is for patients and everyone else who is curious about how psychiatrists work. Using compelling patient vignettes, Shrink Rap explains how psychiatrists think about and address the problems they encounter, from the mundane (how much to charge) to the controversial (involuntary hospitalization). The authors face the field’s shortcomings head-on, revealing what other doctors may not admit about practicing psychiatry.

Candid and humorous, Shrink Rap gives a closeup view of psychiatry, peering into technology, treatments, and the business of the field. If you’ve ever wondered how psychiatry really works, let the Shrink Rappers explain.

Review:

As a medical interpreter I relay what was said in one language in another, so technically I only have to grok the words. However it helps if I know what the speakers are thinking and why they say the things they do. In many cases the patient’s thoughts are simple: “OW. Ow ow ow ow ow – a little help here?” In acute cases the questions make sense: “You have a fever, ache, and chills… have you been in contact with anyone who has the flu?” The one specialty that tends to throw me off, though, is psychiatry. Questions seem to come out of left field and I have no idea what’s going on in the doctor’s head.

Luckily the three doctors who wrote this book have my back. They each have a different area of expertise – hospital psychiatry, forensic psychiatry, and psychotherapy – and their combined depth of knowledge is evident and awesome. We’re shown scenarios with fictitious patients, explaining why the (also fictitious) doctors ask the questions they do, when and why certain medications should be avoided, and what they hope the patient will achieve via treatment.

This look inside psychiatrists’ heads was invaluable for me. I was able to think about cases I’m familiar with and finally realize why a certain medication was stopped, or why the doctor asked a seemingly unrelated question. I have yet to interpret in an institutional setting but I now feel much more prepared to tackle a jail or involuntary hospitalization assignment. The legal system is different where I am, of course, but the basic tenants of treatment remain the same.

In a similar vein, there is a lot of discussion about how psychiatrists are reimbursed and how this or that insurance authorizes treatment. It isn’t relevant to me, and things have probably changed under the Affordable Care Act, but it’s still interesting.

The writing is clear and easy to follow, striking a balance between jargon and a more general writing style. If you have some kind of contact with mental health professionals (like me) or an interest in the area you’ll love Shrink Rap. I’m not sure I would push it on friends not into medical non-fiction, though – give them some Mary Roach first.

Beating Back the Devil by Maryn McKenna

Synopsis:

6759134The universal human instinct is to run from an outbreak of disease like Ebola. These doctors run toward it. Their job is to stop epidemics from happening.

They are the disease detective corps of the US Centers for Disease Control and Prevention (CDC), the federal agency that tracks and tries to prevent disease outbreaks and bioterrorist attacks around the world. They are formally called the Epidemic Intelligence Service (EIS)—a group founded more than fifty years ago out of fear that the Korean War might bring the use of biological weapons—and, like intelligence operatives in the traditional sense, they perform their work largely in anonymity.

In this riveting narrative, Maryn McKenna—the only journalist ever given full access to the EIS in its fifty-three-year history—follows the first class of disease detectives to come to the CDC after September 11, the first to confront not just naturally occurring outbreaks but the man-made threat of bioterrorism. Urgent, exhilarating, and compelling, Beating Back the Devil takes you inside the world of these medical detectives who are trying to stop the next epidemic—before the epidemics stop us.

Review:

I’m a medical interpreter so this book is right in my sweet spot – disease! International locales! Shoe-leather epidemiology, oh my!  (It doesn’t roll off the tongue but go with me here.)

Continue reading “Beating Back the Devil by Maryn McKenna”

What Doctors Feel by Danielle Ofri

Synopsis:

15998346Physicians are assumed to be objective, rational beings, easily able to detach as they guide patients and families through some of life’s most challenging moments. But doctors’ emotional responses to the life-and-death dramas of everyday practice have a profound impact on medical care. And while much has been written about the minds and methods of the medical professionals who save our lives, precious little has been said about their emotions. In What Doctors Feel, Dr. Danielle Ofri has taken on the task of dissecting the hidden emotional responses of doctors, and how these directly influence patients.

How do the stresses of medical life—from paperwork to grueling hours to lawsuits to facing death—affect the medical care that doctors can offer their patients? Digging deep into the lives of doctors, Ofri examines the daunting range of emotions—shame, anger, empathy, frustration, hope, pride, occasionally despair, and sometimes even love—that permeate the contemporary doctor-patient connection. Drawing on scientific studies, including some surprising research, Dr. Danielle Ofri offers up an unflinching look at the impact of emotions on health care.

Review:

A wonderful book for doctors, doctor wannabes, and anyone else involved in medicine. Continue reading “What Doctors Feel by Danielle Ofri”

The Checklist Manifesto by Atul Gawande

Synopsis:

6667514We live in a world of great and increasing complexity, where even the most expert professionals struggle to master the tasks they face. Longer training, ever more advanced technologies‚neither seems to prevent grievous errors. But in a hopeful turn, acclaimed surgeon and writer Atul Gawande finds a remedy in the humblest and simplest of techniques: the checklist.

First introduced decades ago by the U.S. Air Force, checklists have enabled pilots to fly aircraft of mind-boggling sophistication. Now innovative checklists are being adopted in hospitals around the world, helping doctors and nurses respond to everything from flu epidemics to avalanches. Even in the immensely complex world of surgery, a simple ninety-second variant has cut the rate of fatalities by more than a third.

In riveting stories, Gawande takes us from Austria, where an emergency checklist saved a drowning victim who had spent half an hour underwater, to Michigan, where a cleanliness checklist in intensive care units virtually eliminated a type of deadly hospital infection. He explains how checklists actually work to prompt striking and immediate improvements. And he follows the checklist revolution into fields well beyond medicine, from homeland security to investment banking, skyscraper construction, and businesses of all kinds.

Review:

It’s easy to see why this book and the paper at its core started a medical revolution. Gawande makes a compelling case for smart, short checklists for procedures as small as inserting a central line and as large as crash trauma surgery. A well thought out checklist, he argues, will cut down on complications, foster teamwork, and save lives.

Continue reading “The Checklist Manifesto by Atul Gawande”