Monday, March 20, 2017

Review: Medical School for Everyone: Grand Rounds Cases

I really enjoyed all the "Medical School for Everyone" series from the Great Courses, so I was happy to add Grand Rounds Cases to my collection. The same doctor is the primary lecturer for all these audio courses, so there's no concern for the listener that he may be paying for the same material multiple times: as far as I can tell, there is no overlap between all the audio books in the series. Each book/course covers a completely different set of cases.

When I read Algorithms to Live By, one of the interesting stories from the book was how simple mathematical algorithms (no machine learning magic needed!) did a better job of diagnosing patients than even the very experienced doctors who helped to come up with the diagnostic criteria. This set of audio courses is a good antidote to that sort of thinking: in particular, many of the cases covered challenge the doctor not because the diagnosis between differentials (the medical term for diseases/conditions that can match a particular set of symptoms) is difficult or ambiguous, but the extraction of the medical history from the patient required finesse, delicacy, and social skills. For instance, one patient was reluctant to admit to her history with alcohol, misdirecting the medical staff. The need to gain a patient's trust is what convinces me that even if AI was successful in distilling all medical knowledge, to properly substitute for a doctor would require the development of empathy and understanding. That seems to me a much harder job than merely providing an accurate diagnosis when given symptoms.

All of the cases are interesting. Not all of the patients survive, but all are worthy of the half hour or so the lecturer provides. You may or may not want to be a doctor, but by listening to these lectures and the descriptions of the doctor/patient interaction, you'll almost certainly be better equipped to talk to your doctor or be a better advocate for a loved one.

I am reminded of the day when we discussed a possible surgery for my father after he had a fall which turned out to cause bleeding in the brain. The neurosurgeon we discussed the case with looked at the CT scan and told us that the problem could resolve itself, or it could quickly need surgery. We opted to wait but my father deteriorated and we brought him into the hospital via the ED. Afterwards, the neurosurgeon told us he didn't realize that the CT scan was for a recent fall, and that he had given us advice on the basis that this was an old scan! Having listened to this lecture I now know that we should have been on the lookout for this sort of assumptions by a doctor, and summarized the medical history immediately on first contact with the doctor so he wouldn't be prejudiced by his assumptions. In this particular case the situation was rescued only because his primary care doctor looked at him that very afternoon and told us to rush him to the ED right away!

In any case, I think this course/audio book could very well save your life or the life of your loved one. It's well worth your time to listen to it, and if you can, get your spouse/significant other to audit it as well for the day when he/she might have to advocate on your behalf!

Highly recommended.

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