Improving Diagnosis in Health Care


Book Description

Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.




Exercise Oncology


Book Description

This groundbreaking book presents a unique and practical approach to the evolving field of exercise oncology - the study of physical activity in the context of cancer prevention and control. Presenting the current state of the art, the book is sensibly divided into four thematic sections. Following an opening chapter presenting an overview and timeline of exercise oncology, the chapters comprising part I discuss primary cancer prevention, physical activity and survivorship, and the mechanisms by which these operate. Diagnosis and treatment considerations are discussed in part II, including prehabilitation, exercise during surgical recovery, infusion and radiation therapies, and treatment efficacy. Post-treatment and end-of-life care are covered in part III, including cardio-oncology, energetics and palliative care. Part IV presents behavioral, logistical and policy-making considerations, highlighting a multidisciplinary approach to exercise oncology as well as practical matters such as reimbursement and economics. Written and edited by experts in the field, Exercise Oncology will be a go-to practical resource for sports medicine clinicians, family and primary care physicians, oncologists, physical therapy and rehabilitation specialists, and all medical professionals who treat cancer patients.




Neurology in Clinical Practice


Book Description

New edition, completely rewritten, with new chapters on endovascular surgery and mitochrondrial and ion channel disorders.




Every Patient Tells a Story


Book Description

A riveting exploration of the most difficult and important part of what doctors do, by Yale School of Medicine physician Dr. Lisa Sanders, author of the monthly New York Times Magazine column "Diagnosis," the inspiration for the hit Fox TV series House, M.D. "The experience of being ill can be like waking up in a foreign country. Life, as you formerly knew it, is on hold while you travel through this other world as unknown as it is unexpected. When I see patients in the hospital or in my office who are suddenly, surprisingly ill, what they really want to know is, ‘What is wrong with me?’ They want a road map that will help them manage their new surroundings. The ability to give this unnerving and unfamiliar place a name, to know it—on some level—restores a measure of control, independent of whether or not that diagnosis comes attached to a cure. Because, even today, a diagnosis is frequently all a good doctor has to offer." A healthy young man suddenly loses his memory—making him unable to remember the events of each passing hour. Two patients diagnosed with Lyme disease improve after antibiotic treatment—only to have their symptoms mysteriously return. A young woman lies dying in the ICU—bleeding, jaundiced, incoherent—and none of her doctors know what is killing her. In Every Patient Tells a Story, Dr. Lisa Sanders takes us bedside to witness the process of solving these and other diagnostic dilemmas, providing a firsthand account of the expertise and intuition that lead a doctor to make the right diagnosis. Never in human history have doctors had the knowledge, the tools, and the skills that they have today to diagnose illness and disease. And yet mistakes are made, diagnoses missed, symptoms or tests misunderstood. In this high-tech world of modern medicine, Sanders shows us that knowledge, while essential, is not sufficient to unravel the complexities of illness. She presents an unflinching look inside the detective story that marks nearly every illness—the diagnosis—revealing the combination of uncertainty and intrigue that doctors face when confronting patients who are sick or dying. Through dramatic stories of patients with baffling symptoms, Sanders portrays the absolute necessity and surprising difficulties of getting the patient’s story, the challenges of the physical exam, the pitfalls of doctor-to-doctor communication, the vagaries of tests, and the near calamity of diagnostic errors. In Every Patient Tells a Story, Dr. Sanders chronicles the real-life drama of doctors solving these difficult medical mysteries that not only illustrate the art and science of diagnosis, but often save the patients’ lives.




Oxford Handbook of Clinical Diagnosis


Book Description

This handbook describes the diagnostic process clearly and logically, aiding medical students and others who wish to improve their diagnostic performance and to learn more about the diagnostic process.




Knowing Why


Book Description

This anthology includes essays from a diverse group of adult-diagnosed autistic people. Our essays reflect the value of knowing why—why we are different from so many other people, why it can be so hard to do things others can take for granted, and why there is often such a mismatch between others' treatment of us and our own needs, skills, and experiences. Essay topics include recovering from burnout, exploring our passions and interests, and coping with sensory overload, especially in social situations.




Advances in Patient Safety


Book Description

v. 1. Research findings -- v. 2. Concepts and methodology -- v. 3. Implementation issues -- v. 4. Programs, tools and products.




The Neurologic Diagnosis


Book Description

An introductory text that transitions into a moderately advanced, case-based analysis of neurologic disorders and diseases, this book emphasizes how to simplify the process of making a neurologic diagnosis. Medical students and residents are often intimidated by a deluge of data, perception of anatomic complexity, extensive differential diagnoses, and often have no organized structure to follow. Diagnostic methods of general medicine are not applicable. Indeed, neurology is a unique specialty since it requires the intermediary step of an anatomic diagnosis prior to proffering a differential diagnosis. Yet the required knowledge of neuroanatomy need not be profound for the student or resident who will not specialize in neurology or neurosurgery. The Neurologic Diagnosis: A Practical Bedside Approach, 2nd Edition is primarily directed to neurology and neurosurgery residents but it will be useful for medical and family practice residents who will discover that a great percentage of their patients have neurologic symptoms. A one-month neurology rotation out of four years of medical school is not sufficient to make a cogent neurologic diagnosis. The aim of this concise, practical book -- which includes an in-depth video of how to perform a neurologic examination -- is to facilitate the process of establishing a neuroanatomic diagnosis followed by a rigorous analysis of symptoms and signs to reach a well-thought out differential diagnosis. Focused and succinct, this book is an invaluable resource for making a lucid neurologic diagnosis.




Overdiagnosed


Book Description

An exposé on Big Pharma and the American healthcare system’s zeal for excessive medical testing, from a nationally recognized expert More screening doesn’t lead to better health—but can turn healthy people into patients. Going against the conventional wisdom reinforced by the medical establishment and Big Pharma that more screening is the best preventative medicine, Dr. Gilbert Welch builds a compelling counterargument that what we need are fewer, not more, diagnoses. Documenting the excesses of American medical practice that labels far too many of us as sick, Welch examines the social, ethical, and economic ramifications of a health-care system that unnecessarily diagnoses and treats patients, most of whom will not benefit from treatment, might be harmed by it, and would arguably be better off without screening. Drawing on 25 years of medical practice and research on the effects of medical testing, Welch explains in a straightforward, jargon-free style how the cutoffs for treating a person with “abnormal” test results have been drastically lowered just when technological advances have allowed us to see more and more “abnormalities,” many of which will pose fewer health complications than the procedures that ostensibly cure them. Citing studies that show that 10% of 2,000 healthy people were found to have had silent strokes, and that well over half of men over age sixty have traces of prostate cancer but no impairment, Welch reveals overdiagnosis to be rampant for numerous conditions and diseases, including diabetes, high cholesterol, osteoporosis, gallstones, abdominal aortic aneuryisms, blood clots, as well as skin, prostate, breast, and lung cancers. With genetic and prenatal screening now common, patients are being diagnosed not with disease but with “pre-disease” or for being at “high risk” of developing disease. Revealing the economic and medical forces that contribute to overdiagnosis, Welch makes a reasoned call for change that would save us from countless unneeded surgeries, excessive worry, and exorbitant costs, all while maintaining a balanced view of both the potential benefits and harms of diagnosis. Drawing on data, clinical studies, and anecdotes from his own practice, Welch builds a solid, accessible case against the belief that more screening always improves health care.




Before I Forget


Book Description

'Some days all I want to do is give up the constant, exhausting struggle and stop trying to be normal. But I can't. It's not in me to walk away from a fight. I'll keep fighting and telling my story. Before I forget.' When she was just 46, Christine Bryden – science advisor to the prime minister and single mother of three daughters – was diagnosed with younger-onset dementia. Doctors told her to get her affairs in order as she would soon be incapable of doing so. Twenty years later she is still thriving, still working hard to rewire her brain even as it loses its function. The unusually slow progress of her condition puts Christine in a unique position to describe the lived experience of dementia, a condition affecting tens of millions of people worldwide. In this revealing memoir, she looks back on her life in an effort to understand how her brain – once her greatest asset, now her greatest challenge – works now. She shares what it's like to start grasping for words that used to come easily. To be exhausted from visiting a new place. To suddenly realise you don't remember how to drive. To challenge, every day, the stereotype of the 'empty shell'. Brave and inspiring, this is Christine's legacy for people with dementia and those who care about them. 'Christine teaches us that we are more than what our brains are capable of remembering, that while we can still breathe and love, we all have something important to contribute to this world.' Lisa Genova, author of bestseller Still Alice