What medical mysteries can teach us about getting better health care
I checked in with Sandra to find out more about how she writes the column and the lessons we can learn from it.
Here’s our edited conversation.
Q. How do you choose your ideas?
A: It has to be something I haven’t written about. It has to be a solved case. I need to know the ultimate diagnosis. Even though it’s a solved case, there has to be a mystery. And there has to be a human story.
Q. Once you pick a case, how do you report it?
A: I ask for a chronology of events and medical records that confirm the diagnosis. The medical records and chronology enable me to see whether, indeed, this is a mystery, whether it unfolded in an interesting way. Will this be an interesting case?
Then, I interview the patient, sometimes the parent, sometimes the spouse. The last step is to talk to the doctor who made the diagnosis or the current treating physicians. Any step along the way, the process can fail.
Q. Do you write about unsolved cases?
A. No, it has to be a solved case. A lot of people write to me and say, “I have this problem, can you help me?” Unfortunately, that’s not what I do. I did once write about a lawyer in Detroit who had gone to the undiagnosed-disease program at the National Institutes of Health. He’s seen more than 100 doctors and still doesn’t have an answer. But I thought his case was so unusual and interesting, I did make an exception that time.
Q. What are some of your most memorable medical mysteries?
A: I wrote about a family that kept getting recurrent strep throat. They couldn’t figure it out. An enterprising veterinarian got involved. It turned out their cat may have been the vector. When they finally treated the cat, nobody has had strep.
One of the weirder ones — there was a woman who had serious kidney and heart problems. It turned out she was eating too much licorice. That was really odd.
And I still vividly remember a State Department worker who had terrible itching on her head at night. She had even been worked up for a type of cancer. She had seen multiple dermatologists. It turned out she had head lice for an entire year. How did they miss that? That was really stunning.
Q. What have you learned about the medical system from writing about medical mysteries?
A. Medical care has become increasingly specialized. Doctors are familiar with a small slice of what’s going on, yet diagnosis is an inherently complex process. I also think time pressures are worsening. It’s like: “You’ve got 10 minutes. Go.” That’s not going to work with a complicated problem.
I also think sometimes patients are not good at describing the problems. The people who tend to do better are organized and can describe their symptoms in a way that is intelligible for a doctor.
Q. What’s your best advice to patients for getting better medical care?
A. Primary-care doctors can really help a patient. I often see people who go right to specialists. They may not have a primary-care doctor, or they use urgent care when they’re sick. That can be problematic. People really undervalue the role of a good primary-care doctor.
The 2022 Well+Being Gift Guide
Need a gift idea? The Well+Being team shared our favorite finds for cooking, exercising, spending time at home, improving our mental health, presents for your pets and more.
Some gifts are practical and affordable; others are definite splurges. I just bought air fryers for my family members because our Eating Lab columnist Anahad O’Connor recommended it. Runners will appreciate the perfect running shorts recommended by fitness writer Kelyn Soong. Amanda Morris, who writes about disability, suggested hearing-aid jewelry. Reporter Teddy Amenabar has found the perfect traveling coffee mug.
There are lots to choose from, and every item brought us closer to living healthy, fulfilled lives. We hope they do the same for you and your loved ones this year.
Feeling full? Don’t worry. Your stomach probably won’t explode.
This week, a reader asked: I always feel like my stomach is going to explode after I eat on Thanksgiving. Can that actually happen?
While theoretically possible, it is extremely unlikely for your stomach to explode from overeating, said Sophie Balzora, associate professor of medicine at New York University Grossman School of Medicine and a gastroenterologist at NYU Langone Health. She writes:
Your stomach is a tough organ, with thick muscle walls and a rich blood supply that can easily withstand even a hearty Thanksgiving meal.
The stomach also has a remarkable ability to stretch from its resting volume without much change in pressure. Even before that first bite of turkey hits your mouth, the anticipation of it — whether through smell or sight — sends a signal to your brain that’s delivered to your stomach, telling it to prepare for food. As you eat, the stomach stretches, making more and more room.
But stomach rupture has happened. One case report involved a 24-year-old female patient who visited an emergency room in Turkey with sudden abdominal pain, vomiting and nausea after eating an excessive amount of fruit. An abdominal surgery revealed her stomach was perforated and held nearly five liters of partially digested food, including grapes and pomegranate — clearly exceeding a volume that most human stomachs can tolerate.
To learn more, read the full answer from Balzora in Ask a Doctor: If I eat too much, will my stomach explode?
It was another busy week! Check out these stories from the team.
How exercise affects your Thanksgiving appetite: High-intensity exercise can dull your appetite for a few hours. But regular moderate exercise can make you hungrier.
Inviting pets to holiday feast? Know foods you can and can’t share: Veterinarians offer guidance for a fun and safe holiday dinner with your furry family members.
9 tips for handling grief with kids during the holiday season: Check in with yourself and your children, show yourself some care, and create new traditions.
My mother’s dieting affected me, too: My mother’s obsession with weight is not unique. Researchers have studied how a mother’s restricted eating habits can affect her children, particularly daughters.
What’s the difference between RSV, the flu and covid-19? Three respiratory viruses are straining families and hospital systems. Here’s advice from infectious-disease experts.
The ‘most common crippling hand condition’ you’ve never heard of: Often, people with Dupuytren’s contracture mistakenly assume they have arthritis or tendinitis, or don’t notice a problem until their fingers start to bend.
Why it seems like your doctor doesn’t care about you: Many patients define caring as listening, investigating, following up on results and advocating for them. This kind of caring takes time and resources that many doctors are not given, says physician Shirlene Obuobi.
Please let us know how we are doing. Email me at firstname.lastname@example.org.