When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests (Hardcover) newly tagged "health"

"This is a well-written book on an innovative approach to healthcare reform: it challenges patients to take charge of their health and every medical encounter with their doctor. An important topic and an important book--I encourage my patients to read it."
—Siddhartha Mukherjee, Pulitzer Prize-winning author of The Emperor of All Maladies: A Biography of Cancer

"I have always said that a hospital can kill you as sure as cure you. You must be your own best advocate. Follow the advice of Drs. Wen and Kosowsky…and transform from being a patient to an advocate for your own health."
—Fran Drescher, actor, producer, activist, and author of Cancer Schmancer

“It’s critical for patients to advocate for their own health.  This book teaches you how…Read it; it will change radically how you approach your doctors.”
—Melissa Etheridge, Grammy Award-winning musician and host of The Melissa Etheridge Radio Show

“This clearly-written, brilliantly and creatively thought-out book, filled with fascinating and horrifying examples of how doctors are now trained to not listen to their patients in order to ‘rule out’ diseases, focuses on ‘ruling in’ diagnoses that not only are accurate, but that will save billions of dollars per year in lawsuit-driven tests. A brave, terrific, essential work.”
—Samuel Shem, M.D., Ph.D., author of The House of God and The Spirit of the Place

"Leana Wen and Josh Kosowsky have written an authoritative guide to answer a seemingly simple question: How should you talk to your doctor?  Through fascinating examples taken from their own clinical experiences, they show how doctors’ training fails to teach real listening skills.  But Drs. Wen and Kosowsky don't stop there: They also offer up constructive and practical advice that just might save your life."
—Darshak Sanghavi, MD, Chief of Pediatric Cardiology, University of Massachusetts Medical School, health care columnist for Slate, contributing editor at Parents magazine, and author of A Map of the Child: A Pediatrician's Tour of the Body

“Their proposal for ‘diagnostic partnership’ is a major contribution of this courageous book in which common sense plays the leading role.”
—Julio Frenk, MD, PhD, Dean of the Harvard School of Public Health

“A powerful appeal for individualized medical evaluation based on an active partnership between doctors and patients. The rational, mutual approach to diagnosis advocated by Drs. Wen and Kosowsky is the antidote for mindless and wasteful routines that all too often replace careful listening and focused assessment of each patient.”
—Harvey V. Fineberg, M.D., Ph.D., President, Institute of Medicine

“Exposes the stereotypic physician following cookbook recipes to liberating a new frontier in the ‘art’ of humanistic medicine that empowers patients and physicians alike.”
—Lincoln Chen, MD, Director, Global Equity Center at Harvard Kennedy School of Government

“Not only offers a compelling argument for revitalizing this touchstone of good medicine, but also provides a comprehensive guide for how doctors and patients can improve the quality of healthcare by doing so.”
—Jordan J. Cohen, MD, Professor of Medicine and Public Health, George Washington University, and President Emeritus, Association of American Medical Colleges

"This is an important contribution to helping both physicians and patients more effectively manage their encounters.  The authors make it clear that ‘more medical care’ may frequently be harmful to a patient's health.”
—Robert Graham, MD, Professor of Family and Community Medicine, University of Cincinnati

“This book is a must read for informing the dialogue about health care reform and transforming medical education. Its humanistic authors provide support for re-integrating the lost art of humanism with more scientific medicine. The authors’ passion for the individual behind the illness is contagious.”
—Afaf I. Meleis, Ph.D., DrPS (hon), FAAN, Margaret Bond Simon Dean of Nursing, University of Pennsylvania

"Doctors take an oath to do no harm. Yet more than ever, modern medicine makes healthy people sick. Emergency physicians Leana Wen and Josh Kosowski make a passionate argument for patients to get involved and informed about their care. A fast, smart read to help you take charge of your health."
—Audrey Young Crissman, MD, author of What My Patients Taught Me: A Medical Student’s Journey

"Evidenced based medicine, clinical guidelines, and diagnostic algorithms have been widely adopted as an answer to inconsistent and out-of-date medical practice. Drs. Leana Wen and Joshua Kosowsky make the case that the resultant algorithms-gone-wild syndrome seen in many medical settings today actually drives imprecise and wasteful testing, muddled diagnoses, and patient confusion. They argue that these clinical behaviors are at the heart of our “morbidly obese” medical care system and that thoughtful physicians relying on patient narratives and diagnostic common sense will create a leaner medical care system and better patient outcomes. Theirs is a contrarian and compelling case with the wellbeing of millions of patients and $250 billion a year riding on it."
—Fitzhugh Mullan, MD, Murdock Head Professor of Medicine and Health Policy, The George Washington University

“When Doctors Don’t Listen by Drs.Wen and Kosowsky have insightfully crafted a revelation about the workings of modern medicine. It addresses with a finely nuanced balance the basis for our dysfunctional “cookbook style" of medicine. The analysis is not a critical pontification by outsiders, but a pained view by deeply informed insiders. The book pleads powerfully for the disenfranchised patient. It must be read both because most of us sooner or later are bound to seek health care and because the authors provide an important viewpoint for the intensifying nationwide health care debate."
—Bernard Lown, MD, Professor emeritus Harvard School of Public Health, Senior Physician emeritus Brigham and Women's Hospital, Nobel Peace Laureate 1985

“What a brilliant concept – this outstanding book provides an innovative and interesting approach to understanding how physicians interact with patients presenting with an illness and reach a diagnosis. Using a case-based approach followed with careful analysis of the process by two experts in the field of Emergency Medicine, clarity and transparency are provided to one of the most complex areas of medicine, how the physician develops the framework for a diagnosis and orders tests to prove it. Drs. Wen and Kosowsky have given the non-medically trained reader a variety of common scenarios for presentation to the Emergency Department. Physicians often reach a wrong diagnosis by following set pathways hard-wired from years of training and experience. Unfortunately, key words or phrases from the patient which lead the physician down a “typical” pathway for an illness can trigger the wrong answer and result in a large number of expensive, time-consuming, and potentially harmful tests. By teaching the patient the importance of providing the essential information on their illness to the physician, and making sure the physician actually listens to them, the likelihood that the physician makes the correct diagnosis increases substantially. This excellent book contains a literal treasure trove of information which will be beneficial and educational for patient and physician alike. As popular as the ED has been over the last two decades, pictured in television shows such as “ER” and other medically oriented television series, I anticipate this book will be widely read, very successful, and often quoted, not only by the lay public but also the medically-trained care providers who strive to listen better to their patients.”
—W. Brian Gibler, MD  FACEP, FACC, President and CEO, University Hospital, Senior Vice President, UC Health, Professor of Emergency Medicine, University of Cincinnati College of Medicine

Dr. Leana Wen is a physician at Harvard and Brigham & Women's Hospital/Massachusetts General Hospital. Inspired by her own childhood illness and then her mother's long battle with cancer, Dr. Wen is a recognized expert on patient advocacy and patient-centered care. A Rhodes Scholar, she graduated with distinction from the University of Oxford and Washington University School of Medicine. She has served as a consultant to the World Health Organization, Brookings Institution, China Medical Board, and the National Institutes of Health, and is currently the National President of the American Academy of Emergency Medicine/Resident & Student Association.

The 2007 winner of The New York Times journalism contest, Dr. Wen has reported in Africa with journalist Nicholas Kristof, and has written for The Lancet, Journal of American Medical Association, The Washington Post, among others. Dr. Wen is traveling around the U.S. and in Europe, Asia, and Africa to speak about patient empowerment and her first book, When Doctors Don't Listen: How to Prevent Misdiagnoses and Unnecessary Tests.

Dr. Josh Kosowksy is an expert clinician and the clinical director of the Brigham & Women's Emergency Department. He is a former Fulbright Scholar and a graduate of Harvard College and Harvard Medical School. A director of the "Introduction to Clinical Medicine Course" which helps prepare Harvard medical students for their hospital clerkships, he has introduced innovative elements to the curriculum around patient-physician communication. Dr. Kosowksy is the author of dozens of journal articles and textbook chapters, and has given invited presentations to hundreds of hospitals and medical schools around the country. He serves on the Editorial Board of a half-dozen medical journals, ranging from Annals of Emergency Medicine to The American Journal of Cardiology.

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Hungry: Lessons Learned on the Journey from Fat to Thin (Hardcover) newly tagged "health"

Weight loss advice, laughter, and inspiration from the delicious, caloric, yet uncomfortably large life experiences of a formerly fat man.

Allen Zadoff spent years reasoning that a big, healthy man should have a big, healthy appetite and that his rapidly increasing girth was no more than a regular guy thing.

At 350 pounds, however, it became clear that what had started as a little weight problem was destroying his life. Desperate to find a new way of living that would carry him into thin and beyond, Zadoff began to focus less on what he ate, and more on the physical and emotional underpinnings of what he came to understand as a disease. The pounds melted away, and so began the adventure of a lifetime.

Following Zadoff's incredible journey both up and down the scale, Hungry blends his personal story with surprising strategies for weight loss success; it is as laugh-out-loud funny as it is inspirational.

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Counterclockwise: Mindful Health and the Power of Possibility (Hardcover) newly tagged "health"

Michael Hogan, National University of Ireland, Galway: michael.hogan@nuigalway.ie

This review is based on my reading of all 4 of Ellen Langer's books, which I was inspired to read after meeting Ellen in Harvard recently.

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Ellen Langer is one of the most vivacious women I have ever met. Upon arriving to meet her in Harvard's William James Hall, I was actually extremely ill, but mindlessly ignoring the symptoms. The painful and yet irrelevant swelling in my right leg and the weak and feverish state that led me to sleep through a very stimulating lecture by Daniel Dennett, was in fact a serious blood infection that would later result in my hospitalization. Little did I know that my conversation with Ellen Langer would be the thing that completely transformed my hospital experience from a potentially stressful, painful nuisance into a very interesting and rewarding experience. And notwithstanding the fact that I could hardly talk, in our short walk from Ellen's office to the Harvard clinic (where Ellen was going to get a cut in her hand seen to, the cause of which she transformed into a very interesting story) we designed three experiments and I experienced firsthand, in vivo, decades of research on social and developmental psychology, and on mindfulness, creativity and decision-making.

To understand the transformative power of Ellen Langer's perspective, and to better understand her creative action, I believe it is useful to experience firsthand her version of mindfulness -- the act of noticing new things -- which is actually very easy to practice, if for no other reason than it energizes and engages us and opens us to new possibilities. Further, it is useful to consider the way Langer applies her version of mindfulness to understanding of social psychology and developmental psychology phenomena, and science generally. Her thought, as laid out in her four books on mindfulness and in her many empirical papers, represents a veritable stream of understanding that liberates one from a constrained, passive, rigid view of reality, possibility, and human potential.

Noticing new things

Ellen and I both teach social psychology. A critical reading of social psychology reveals much to us about the conditions under which people impose rigid, stereotyped views upon themselves and other people, and the conditions under which behavior is a rigid function of contextual control [1]. What is often so startling to students who first discover social psychology research is just how rigid, stereotypical, and limited our worldviews and our behaviors often are. Nevertheless, every year, one or two students in my first year social psychology class approach with great excitement and tell me how inspired they are to discover all these human limitations so carefully catalogued by social psychologists. Awareness of the conditions shaping rigid, stereotyped thinking and action, they tell me, has actually liberated them. Some report feeling more open to experience, less rigid in their evaluation of self, other, and world. They report clearer perception, greater awareness of the subtle nuances of experience. They are noticing new things. They are energized and inspired. Some go a step further, extrapolating and anticipating the open field of possibilities: they report a transition from mindless acceptance of all that they know and feel and do, to mindful awareness of all that they can know and all that they can feel and can do. Their prior learning no longer dominates the way they interpret the present moment. The fullness of the present moment itself and the possibility space that opens by virtue of the fusion of present moment with the ineffable future moment infuse their field of action with a new radiance. All is new. The well-springs of creativity are open. Reality and potentiality comes flooding in.

Mindless reading of health-related information

Some students, I believe, remember the raw significance of their inspired insight as they progress to higher levels of ability and skill -- they remember to notice new things -- they remember mindfulness. It's a subtle change in thinking, says Langer, although not difficult to make once we realize how stuck we are in culture, language, and modes of thought that limit our potential. Social psychology education provides a wonderful opportunity to shed light upon mindfulness and mindlessness. Experimental social psychology is full of examples of the price people can pay for mindless learning, or mindless assimilation of their `culture'. Research by Chanowitz and Langer (1981), for example, demonstrates the negative consequences of mindless reading of medical information. They provided students with information booklets about a disorder called "chromosythosis", a condition that could lead to diminished hearing. Some of the students were told that 80% of the population had the disorder and they were asked to imagine how they might help themselves if they were diagnosed as having "chromosythosis". Another group was told that only 10% of the population had it, making the disease seem less relevant to them, and they were simply asked to read through the information booklets. All students were then tested to see if they had the disorder and all were told that, yes, they did indeed have it.

In the next phase of the experiment, participants were tested using a series of objective hearing tests. Those participants who were led to believe that the disorder was less relevant to them and who simply read through the information booklets, performed significantly worse on the hearing tests than the group who were led to believe that the disorder was potentially relevant to them and who also thought through the consequences of having the disorder. Langer describes this as one example of the negative effects of premature cognitive commitments. Specifically, when information is mindlessly received and accepted without critical question or creative `what if' deliberation, we run the risk of implicitly committing to a singular, rigid understanding of the information. When later we are faced with a situation where this `prior learning' is brought to bear on our action in context, we may find ourselves functionally constrained by the rigid understanding we have implicitly established. Mindless reading and mindless learning result in mindless reactivity.

Mindful Health and the power of possibility

Langer considers how mindfulness operates when people learn that they have cancer. Although science is learning that cancer can be a chronic condition or even fully treatable, most of us, says Langer, mindlessly assume that cancer is a "killer". Rather than being mindfully aware of our symptoms and the conditions associated with the presence and absence of symptoms at any given moment in time, rather than being mindfully aware of the variable nature of our interactions with medical professionals, friends, and family, or changes in the way we work and play, and so on, one possible outcome is that the trauma associated with the diagnosis of cancer leads us to identify fully with the label "cancer patient". As soon as we identify with the label, all the preconceived ideas we ascribe to the label come to control our behavior.

But this is only one possibility and not everyone responds in the same way when diagnosed with cancer. Langer refers to research by Sarit Golub (2004) conducted in Harvard. Golub found that while some people diagnosed with cancer add cancer to their identity, others let the diagnosis take over their identity, with the latter group faring less well on measures of recovery and psychological well-being.

Langer suggests that mindfulness makes us more optimistic because we are open and attentive to possibilities, and that this in turn facilitates recovery. Research does suggest a relationship between mindfulness and optimism [2], and between optimism and recovery from coronary artery bypass surgery [3]. Converse to the view that optimists have a rosy view of their future that invariably leads them to ignore their present circumstances, Langer believes that mindful optimists are likely to pay greater attention to their recovery than do pessimists, and in so doing they aid the recovery process and help anticipate complications.

Nevertheless, mindless optimism and mindless pessimism may lead people to invest more heavily in positive or negative systems of belief than in reality itself and the possibilities that reality presents [4]. Thus, mindful optimism is unique: optimal well-being, according to some, hinges on a capacity to open oneself to the subtleties and complexities of reality and thus inhibit cognitive commitments that pit belief against experience [5]. One belief that Langer asks us to be mindful of in this context is the belief that science trumps experience. If, for example, we blindly assume that medical science is simply better than our own experience in informing our judgment and action, we may be inclined to mindlessly hand over control of our health to the `experts' and thus ignore the subtle variation in our experience (e.g., our experience of symptoms) and contextual variables that impinge upon our experience. Again, by accepting some label attached to us in consultation with a doctor (e.g., "chronic pain patient") we may come to assume more stability in our condition than there is; we may hand over control of our condition to others, and thus negate the possibility space that opens to us when we are mindfully aware of our condition.

Mindful awareness of our state can enhance our ability to control our state. Read more ›

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The Whole Life Prostate Book: Everything That Every Man-at Every Age-Needs to Know About Maintaining Optimal Prostate Health (Hardcover) newly tagged "health"

“Men today face myriad choices when it comes to their prostate care and prostate treatments. Dr. H. Ballentine Carter brings his enormous talents and knowledge to help them in this groundbreaking new book. This book should be read by all men, and their loved ones, whether establishing a prostate health regimen or facing a prostate crisis.”

—Mehmet Oz, MD, Professor and Vice Chair, Department of Surgery, New York Presbyterian-Columbia Medical Center

“Dr. H. Ballentine Carter has been pioneering prostate treatment for his entire career. Now, he brings his ideas and knowledge to everyone—and the impact will be profound. This book changes the landscape in prostate health and improves people’s lives.”

—David B. Agus, MD, Professor of Medicine and Engineering, University of Southern California, and author of The End of Illness

“This is a comprehensive resource that will be a great help to all men and the people who love them. Dr. Carter takes men from infancy straight through their later years and clearly details what needs to be done to maintain optimal health. This is an essential guide—now more than ever.”

—Alan W. Partin, MD, PhD, Director and Professor, the Brady Urological Institute, the Johns Hopkins Hospital

“I have long been a fan of Dr. Carter’s research and witness to the personal care that he gives to all his patients. I’m grateful that he has now made available his hands-on experience to everyone in this easy-to-read, practical book that provides such good sense in an arena of medical decision making that too often is dominated by hype and fear.”

—Herbert Lepor, MD, Professor and Martin Spatz Chairman, Department of Urology, NYU School of Medicine

“The prostate, a small and enigmatic organ near the bladder in all male mammals, appears to be disproportionately afflicted by a bewildering collection of conditions as men age. This book captures the wisdom of Dr. H. Ballentine Carter, the most thoughtful urologist in the world today and a renowned expert on the detection, diagnosis, prevention, and treatment of prostate diseases. Writing with Gerald Couzens, a seasoned medical author, the prostate health information delivered is not only definitive but remarkably accessible—with myth busters, red flags, and takeaways provided to guide as well as inform men confronting prostate diseases. The book is certain to become required reading for men of all ages, and for their loved ones, as they seek to live longer, healthier, and happier lives.”

—William G. Nelson, MD, PhD, Director, Sidney Kimmel Comprehensive Cancer Center, the Johns Hopkins Hospital

H. Ballentine Carter, M.D., is professor of urology and oncology and the Director of Adult Urology at the Johns Hopkins University School of Medicine. An internationally recognized expert in the diagnosis and treatment of prostate disease, he lives in Maryland.

Gerald Secor Couzens writes about health issues for various publications, including The New York Times, and is the author or coauthor of several books on health and medicine. Managing editor of The Johns Hopkins Prostate Bulletin, he lives in New York City.

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