Warm and Dead

That's one of the aphorisms from Every Patient Tells a Story -- guy is brought into the ER after falling asleep in a snowbank. No life signs, and they think he's dead. The attending says 'You're not dead until you're warm and dead' -- so they warm him up slowly, and as he warms up, they begin to hear life signs. The guy recovers and walks out of the hospital under his own power.

The book's about the science and art of medical diagnosis, and though it lumbers a bit from time to time, it's pretty well done. I always thought that diagnosis was just a matter of knowing enough -- that if you could have access to enough data sources, coming to a diagnosis would be easy. Now I'm seeing that knowing isn't enough; you need to be able to pick up on the things that don't seem significant -- a particular trick when part of creating a diagnosis is stripping away the details that don't matter -- or string together the things that do matter -- which came first, which was the result -- and then draw the correct conclusions from that series. One fellow who came in with severe chest pains died because the medical student taking his blood pressure couldn't get a reading in one arm, and thought it was his inexperience -- when in fact it was a known indicator of aortic dissection (the thing that killed John Ritter).

The author quotes the stats about communication -- that doctors are eager to cut to the chase and start making a diagnosis, often cutting off a patient's story flow after fifteen or twenty seconds. But it's not until they've talked for a while that many people feel comfortable relating why they really came, what's really bothering them. Every doctor's heard of 'doorknob questions', the ones that come just as they're leaving the examining room. Hey, doc, while you're here, I've got this bump on my neck....

It's an interesting book.