This book about the practice of diagnosis and the need for it to be better was a fascinating addition to my collection on the current state of healthcare. In The Elusive Body: Patients, Doctors, and the Diagnosis Crisis, Alexandra Sifferlin does really interesting work to unpack what the issue with diagnosis really is: why so many people get incorrect ones, the potential costs that can have, and how it might be able to get better.
One of the answers, naturally, is how much of our healthcare system comes down to insurance, which needs a clear diagnostic code for many tests to be justified, making it ideal to jump to the easy answer and stick to it. Various biases also encourage this—the easiest answer is the most likely, but when that's colored with fatphobia, misogyny, or racism, it can do damage. An astonishing 1 in 15 people will, at some point in their lives, have a rare health condition, and yet doctors are often too quick to dismiss the rare entirely. Partially due to time pressure and partially to the lack of hands-on medical education, the physical exam and listening portions of a doctor's visit are becoming lost arts despite being the most crucial pieces of the puzzle according to all data. There's also a marked lack of collaboration between kinds of doctors—even in good systems, your cardiologist rarely talks at any length with your primary care or dermatologist.
Between the need for speed and the pressure to cure, doctors are very uncomfortable with uncertainty and the possibility of being wrong. It's difficult to ever find out if you were wrong about a diagnosis, and few doctors track their cases. But there are many programs out there that demonstrate ways to achieve better diagnosis, and many people who are fighting to get studies like this into medical education so that the next generation can be better at having the right tools and mentalities to get to a good or functional diagnosis, and at being honest and transparent with the patient. This was an interesting deep-dive into a lot of the issues underlying chronic illnesses, rare conditions, and more, and hopefully can be an informative work for doctors and medical pros as well as patients.
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