Monday, July 09, 2007

How Doctors Think

Writing in City Journal, Paul Howard reviews Jerome Groopman's book, How Doctors Think. An excerpt:

How Doctors Think opens with a stark example of misdiagnosis: the story of Ann Dodge, a woman in her thirties who was literally wasting away, despite consuming 3,000 calories a day under doctor’s orders. In her early twenties, Dodge had developed nausea, stomach pain, and vomiting after meals. Initially, her primary-care physician prescribed antacids. When the condition persisted, he sent her to a psychiatrist, who diagnosed her with anorexia. Over the next 15 years, 30 physicians treated Dodge, eventually concluding that she suffered from irritable bowel syndrome. Her doctors recommended that she consume massive amounts of cereals and pastas, but instead of getting better, she steadily lost weight and developed severe osteoporosis.

At her boyfriend’s insistence, Dodge sought out gastroenterologist Myron Falchuk. Falchuk inherited Dodge’s copious medical history, which attributed her illness to her fragile mental state. Falchuk, Groopman writes, “heard in [Dodge’s] doctor’s recitation of the case the implicit message that his role was to examine Anne’s abdomen . . . and to reassure her that irritable bowel syndrome . . . should be treated as the internist had recommended, with an appropriate diet and tranquilizers.” Instead, Falchuk did an extraordinary thing: he pushed her stack of medical records aside and asked her to tell her story from the beginning. After conducting a long interview and physical exam, Falchuk ordered several tests that confirmed his diagnosis: celiac disease—an allergic reaction to gluten, a substance found in many grains. In other words, Dodge’s carbohydrate-rich diet was killing her.

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