Great News! The project is complete: book is published, find it on Amazon.
A storytelling medical book for patients
Symptoms and Diagnosis: Are you asking the wrong question?
This is the proposed title of the book. It may change by the time the final book is ready to be published but the theme of the book will be the same. It will be about symptoms and diagnosis in real patients.
Overview: Symptoms and Diagnosis
I have been practicing Internal Medicine for the last ten years. Everyday I admit patients to the hospital with different symptoms. Although the symptoms can be categorized into different classes and different medical terms can be assigned to them, I know that every patient experiences these symptoms differently. Even when two patients get the exact same diagnosis, they do not have the exact same symptoms. More importantly, two patients with exact same set of symptoms can have completely different diagnosis based on the unique circumstances of the patient.
Despite the individual variation in the symptoms of any particular disease, the most common question that people ask me is: “What are the symptoms of this particular disease?” Well, I could simply give them a short list of symptoms that are considered the typical symptoms of the disease but that would not be very useful.
Symptoms and Diagnosis: a personal experience of what could go wrong with a simple answer
I had a personal experience very early in my medical career when someone asked me a similar question. It happened more than twelve years ago but it still brings back an unpleasant sense of guilt every time I think about the incident. I was a third year medical student at the time. I was very proud of my medical knowledge and felt like I knew a lot about medicine. Just like all third year medical students, I was always trying to impress people with my medical knowledge in the hope that someone might take my words seriously.
One day, a friend of my friend whom I had only met a few times called me and asked me a few questions. I thought it was just a social call and we had a normal friendly conversation. She then asked me about my medical school experience and I told her how much I loved medicine and how excited I was to be learning about symptoms, diagnosis and treatment. She then asked me if I knew what the typical symptoms of a heart attack were. I was a little surprised to get that question out of the blue and thought for a while about asking why she needed to know. But my enthusiasm about the topic prevented me from asking that question and I assumed she just wanted to know. I simply told her what I had read in the text books about the typical symptoms of a heart attack. She thanked me and seemed impressed with my medical knowledge. I felt really good about the conversation after I hung up.
I did not know what I had done until my friend called me the next day. The father of that girl died from a severe heart attack. He was a 65 year old man. He had some mild discomfort in his chest but refused to get any help for it. It was just a mild discomfort and he thought he might have pulled a muscle. The daughter was a little concerned. She knew that I was in medical school but we were not very close and she was reluctant to ask me directly if she should be concerned about her father’s symptoms. Instead, she just made it sound like she was interested in knowing the symptoms of heart attack just out of curiosity. If she had told me about the symptoms of her father and had asked me if she needed to be concerned, I would have told her to take him to the ER right away. Even as a third year medical student, I knew that many patients with heart attacks did not have the typical symptoms. I knew that any chest pain in a 65 year old male needed to be taken seriously.
Are you asking the wrong question about symptoms?
Most people are still asking the question about symptoms in the same wrong way. Especially, in this age of internet, too many people are repeating the same mistake. Unlike that girl, people do not even need to know anyone in medical school to repeat that question. When they are concerned about a particular disease, they just type “symptoms of …” or “common symptoms of …” and try to find websites that describe that disease and list the common symptoms. Unfortunately, there are too many websites that target people like that. For example if you search for the phrase “symptoms of pneumonia”, you will get about twenty one million results. The first page lists 10 websites that are very reputable and considered authentic medical websites. They all list the detailed symptoms of pneumonia very accurately. They even list the different types of pneumonia and list slightly different symptoms under each category. This information is very valuable to someone who is curious about the symptoms and types of pneumonia in general. They describe pneumonia symptoms in great detail but they do not describe the patients with pneumonia. They consider symptoms as something factual and objective.
But symptoms are not objective data. Symptoms are as subjective as the individual describing them. Symptoms are felt by the patients and as you know feeling is very subjective as personal. Two patients suffering from the same type of pneumonia do not feel exactly the same. Many people who searched “symptoms of pneumonia” were not just people curious about symptoms of pneumonia. They probably were concerned about someone who could have pneumonia. Some of them may try to match the listed symptoms with what that person is having and may be falsely reassured when the lists do not match.
The important point that most people forget under these circumstances is that the severity of pneumonia or the risks of complications do not have any relation to how closely the symptoms match the list. Someone may have only one of the ten symptoms listed in the website. But that patient can easily have the most severe or the riskiest type of pneumonia. The risks of complications from pneumonia do not depend on how typical the symptoms of pneumonia are. The risks of complications depend on who the patient is. It depends on what other medical problems the patient had. It depends on how old the patient is. It depends on how active or sedentary the patient is. It depends on how fat or thin the person is. It also depends on how many packs of cigarettes the patient has smoked in his/her life.
The correct way to think about symptoms
The correct way to think about symptoms is to think about the patients first and that is what I plan to do in this book. I will describe patients before describing their symptoms. Unlike the lists in the textbooks or the websites, the patients I take care of are real people with real lives. To know my particular patient, I have know about the life of the person in front of me. I have to ask very detailed questions and need to get a very up close and personal look at the patient’s life. I will only be able to put the symptoms of the patients in the right context when I know the person well.
Here is your chance to be a part of the “Symptoms and diagnosis” book project
If you have any questions or comments that you want answered in the book, please put down your comments below. If your idea gets picked up by the publisher, you will have the chance to get your name published in the acknowledgement section of the book. Go ahead, tell us what you want to read and be an important part of the project.