The Lost ‘Art’ of Practicing Medicine: A Q&A with Dr. Leana Wen author of ‘When Doctors Don’t Listen’ –How to Avoid Misdiagnoses and Unnecessary Tests

Aug 6, 2014 by

WWB’s ‘Book Wise’ Pick

WWB’s  ‘Book Wise’  Club Pick: When Doctors Don’t Listen–How to Avoid Misdiagnoses and Unnecessary Tests

WWB’s Wise Guru/Author Bio: Dr. Leana Wen is a Harvard-educated emergency physician, Rhodes Scholar, TED speaker, and author of the best-selling book,When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests  (Co-authored with Dr. Joshua Kosowsky, M.D.)

Dr. Wen is a practicing attending physician and Director of Patient-Centered Care in the Department of Emergency Medicine at George Washington University. A professor of emergency medicine and health policy, she co-leads a new national collaboration on health policy and social mission, and serves as founding director of Who’s My Doctor, a campaign calling for radical transparency in medicine.

In addition to World Wise Beauty, she has been featured in TimeNewsweekABC News, NPR, CNN, The New York TimesThe Washington Post, and the award-winning HBO documentary Reporter. A professional speaker for ten years, she has given three popular TED talks, and lectures around the U.S. and internationally on patient-centered care and healthcare reform.

 

 

Lauroly Opening: Welcome Dr. Wen to World Wise Beauty. I am honored to have you join us and I’m such an admirer of your work. It takes courage to step out of the “tribe’ you run with, and in your case the tribe is the medical establishment you are a part of. After I read your book, I likened it to another great book I read called ‘Emperor of All Maladies’ and then I noticed the author was one of your top reviewers on your back cover! I say your book is ‘great’ because I think it is incredibly hard to step back and be objective about what we are doing when we are in the ‘trenches’ of our work. It’s must be so hard to critique your own field of expertise when to an extent you are ‘indoctrinated’ with training and conditioning from the moment you enter medical school.  I commend you for your personal insight and your bravery to step up and challenge your own peers.

I am also thrilled to announce your book has been chosen as the first WWB ‘Book Wise’ club pick. While there are many excellent books out there, I select books that speak to my two important missions for World Wise Beauty. The first one is to advance wellness culture through enlightenment and education. The second one is to help women embrace beauty from the inside out and to encourage them to be comfortable in their own skin. Your very important book has been selected because you are clearly determined to advance wellness culture. There is so much information to glean from your book, so let’s  get started!  

Lauroly Q- Some people refer to your work as ‘disruptive’ which is a trendy, mostly positive term used today when alternative options and ideas are introduced. I see your book as simply enlightening because you really try to get at the real problem in today’s medical practice for both doctors and patients. You give us the full balanced picture of how the practice of medicine has advanced in some areas but also has lost its way, and particularly when it comes to listening to the patient and making a diagnosis. Why is it more important than ever for patients to be their own strong advocate when interacting with medical professionals? I do want to point out that your book is not about fear or blame, it’s about knowledge and empowerment for both medical practitioners and patients.

 

Dr. Leana Wen

 

Dr. Leana Wen: Thank you for the opportunity to comment on this important issue, and I appreciate your recognition of this being about knowledge and empowerment, rather than blame. Over the years, I have worked with many excellent doctors and nurses, and not one person intends to misdiagnose or contribute to unnecessary testing. What I’d add is this: making a diagnosis requires a partnership between you and your doctor. The doctor is the expert when it comes to medicine, but you are the expert when it comes to your body–the two of you together need to come up with your diagnosis. Patients can’t be passive recipients of healthcare.

Lauroly Q- Your medical experience and wisdom comes from working as a doctor in the ER of a hospital. I think working the ER is hard-core training for any doctor, and really tests your communication abilities because you interact with so many people from all walks of life. Yet lack of communication seems to be the big problem and is exactly where things are going wrong for many patients right? Your book illustrates the problems by highlighting three patient stories who fell victim to ‘Cookbook Medicine’. You also share numerous tips throughout the book on how to avoid falling into the wrong ‘pathway of diagnosis’ ( using ‘pathways’ is a common practice today in hospitals). What is cookbook medicine and explain how it is practiced?

 

New Yorker, Cartoon Editor, Bob Mankoff

 

Dr. Leana Wen: Cookbook medicine is what happens when patients are given the same treatment no matter who they are or what they present with. So if you have a chest pain and you fell into a wall, you get the same treatment as if you are in your 80s and have crushing chest pain–that’s practicing medicine by a recipe, not personalizing treatment to the individual patient. We know from numerous studies that 80% of diagnoses can be made based on the history, yet doctors today are under a lot of pressure to see more people in less time. In fact, studies show that doctors will interrupt patients in 10-12 seconds after they begin speaking. It becomes tempting to practice this form of cookbook medicine, which might save time, but patients will suffer the consequences. That’s why it’s so important for patients to advocate for themselves to make sure they get the best care possible.

 

 

Lauroly Q- Throughout the book you have ‘911 Action Tips’ and ‘911 reviews’ after each chapter. It’s so informative and I believe the most important one you share is on page 152– ‘Be Involved in your personal exam’. I do have to say, when you’re in pain and distress, it isn’t always easy to think and communicate clearly! As you just mentioned, doctors today are under more pressure to see more patients in less time. This is a big issue you cover comprehensively from all sides of the fence.

The only area I didn’t find you covered is my next important question. You are asking your own field to essentially stop giving unnecessary tests but aren’t hospitals ‘for profit’ centers and isn’t their technology and tests a huge part of their profit centers? I couldn’t help but think about this big elephant in the room. Is a doctor’s end goal to heal or make profits for their hospital and practice? Perhaps there is a ‘value crisis’ in the practice of medicine? I don’t think doctors think like this from day to day, but as you point out so well in your book, they are conditioned from the moment they enter med school. I know this is a difficult question to tackle but I believe you are up to the challenge!

 

Dr. Leana Wen: This is a really excellent question, and I’m so glad you mentioned it. We do have a big problem in medicine: that more is considered better. This is a problem with many causes, including patient expectations, media perceptions, and the profit motives that you mentioned. A 2008 study in the New England Journal of Medicine found that 94% of doctors have some affiliation with drug companies or medical device companies. Subsequent studies have shown that these affiliations do change prescription habits. There is a growing movement of doctors who know this is a problem: we have to make sure our best interests are always the patients’ best interests, and in fact that’s why we entered this practice of medicine–to heal and to serve. I started a campaign last year called Who’s My Doctor, www.whosmydoctor.com, that aims for total transparency in medicine. We want to assure our patients that we will be totally open with them, that we have nothing to hide from them. And all of us, as patients and providers, need to come together to address this larger issue of “more is better” medicine, and to focus on what’s actually good for people, not just for profit.

 

Lauroly Closing: Thank you so much for stopping by Dr. Wen. I am recommending that EVERYONE read your book “When Doctors Don’t Listen’. I  know my followers will see why it has been selected as the first WWB ‘Book Wise’ pick. I look forward to seeing you out there advocating for us! WWB will do its best to promote your book because it teaches us, enlightens us, and most importantly empowers us to become ‘wise’ about our own health and medical care. We all have to be wise gurus for ourselves and our families. Go wisely my friends…

Truly Herself,
Lauroly

 

 

 

 

 

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1 Comment

  1. MUQ

    Nice Post!
    Thanks For Sharing!

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