Sunday, September 11, 2016

Book Review: Making Sense of Medicine

During the 9 years I have written this blog I have read and reviewed a number of books by cancer patients, their caregivers and their physicians.  The focus of these books has always been cancer. During that time period I have also promoted the need for more patient-centered care. My definition of patient centered care is treating the person not the disease based on the individual patient's needs and situation.

When Dr. Zachary Berger, ( @ZackBergerMDPhD), a physician at Johns Hopkins, who I follow on Twitter, tweeted that he had published a new book,  Making Sense of Medicine-  Bridging the Gap Between Doctor Guidelines and Patient Preferences I was interested in reading it.  I wondered how he would describe the importance of patient-centered care from his, a physician's, perspective.

His book contains chapters on various common chronic diseases - High Blood Pressure, Arthritis and Diabetes. Within each chapter is the story of his patient's experience with illness and his interactions with those patients. Some of those interactions were funny and after reading some I was angry at the situation. I could identify with some of the stories as patients with multiple diseases dealt with the system. Although there is not a separate section for or about those living with cancer there are chapters that are useful to the cancer patient and survivor such as Depression, Surgery, Guidelines and Is Half of all Research Wrong?.

His chapter on Poverty : Making Decisions, Our Health System - And You in the Middle is very thought provoking and points out the health care disparities in the United States. Berger writes " we don't get the right treatments to exactly the right person just when and where they need it ." He goes on to say "And giving too much care is a subset of this problem."

As I read the book I underlined many phrases and paragraphs.

When I read "...The biomedical assumption that knowing what is broken will tell us how to fix it is not always justified". I thought of a friend who turned down a spinal tap to see if there was cancer in her brain because she had decided to stop treatment.

When speaking of guidelines Berger says " there is no perfect evidence that matters the same way to everyone, everywhere". That is why asking patients their needs and wants is so important.This section is the only one in which I would add that ASCO (American Society of Clinical Oncology) is including patients on all their Clinical Guideline Panels and they are having a voice as those guidelines are developed.

Reading "There will always be such situations in which the personal question outpaces the available scientific evidence." I thought of cancer patients with multiple recurrences / metastatic disease with different treatment options available to them and being in uncharted waters.

In Revisiting the Biomedical Paradigm he writes"Identifying conditions (diseases) through signs , symptoms, following them up with diagnosis and pursuing effective treatment is not the only effective path to help . " He recommends a more sensible approach "science of the individual". Yes!

I could go on but I would prefer that you read the book and find the sections that speak to you and an individual patient, doctor or caregiver .

If you are a patient, caregiver or health care provider I highly recommend Making Sense of Medicine. It will make all of you think. Patients, I hope it empowers you to ask questions and become a partner in your health care.

I appreciate the opportunity to read and review this book.

Every Day is a Blessing! 

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