DIAGNOSIS

Audio-book Review
By Chet Yarbrough

(Blog:awalkingdelight)
Website: chetyarbrough.com

Medical School for Everyone: Grand Rounds CasesMedical School for Everyone

By: Professor Roy Benaroch

Narrated by: Lecture

ROY BENAROCH, MD (ADJUNCT ASST. PROFESSOR OF PEDIATRICS, PRACTICING PEDIATRICIAN)
ROY BENAROCH, MD (ADJUNCT ASST. PROFESSOR OF PEDIATRICS, PRACTICING PEDIATRICIAN)

Dr. Roy Benaroch offers physicians and the general public information on the diagnosis of medical conditions in lectures titled “Medical School for Everyone”.  This may seem an odd selection for an audiobook enthusiast who is not a physician.  However, a listener will find Benaroch’s lectures offer valuable tools for understanding what a competent doctor does when diagnosing patients.

Equally, Benaroch offers practical and insightful information about 21st century medicine and actions that might be taken by a non-medical person in a medical emergency.

Much of what Benaroch explains is timely; i.e. belief in immunization, treatment for heart disease, cancer, concussion, ADT, MS, autism, depression, and dementia are subjects that touch every person’s life.  Benaroch suggests obesity may be the biggest, certainly the broadest (no pun intended), medical problem facing the general public, but not because it is a disease.  Obesity is a condition, a condition that leads to, or aggravates, many of today’s’ medical maladies.

Benaroch is a professor but also a medical practitioner who every patient would like to have.  Benaroch suggests “listening to what a patient has to say” is the first and most important step in the diagnostic process.  The art of listening focuses doctors on what is bothering the patient.  By listening, a diagnosis is more likely based on a patient’s need, rather than a physician’s preconceived opinion.

Case studies of patients are offered in Benaroch’s lectures.  With explanation of the diagnostic process, a listener discovers useful information about themselves; not as a patient, but as a student of desired insight to what may cause fatigue, dizziness, fever, sweating, snoring, shortness of breath, coughing or other common ailments. For medical treatment, Benaroch’s lectures explain the importance of chest compression when someone is having a heart attack;

how, contrary to myth, one should not put anything in a person’s mouth when they are convulsing;

and additionally, why population’ immunization is so critically important.

Benaroch explains the difference between dependence and addiction.  He notes how some patients have become addicted to prescription drugs.  He discloses a case study that reveals methods addicts use to hoodwink physicians into prescribing opiates.  Benaroch explains how one may become dependent on an opiate without becoming addicted.  Benaroch notes how care of a physician is distorted when the importance of reducing pain is confused with addiction.

Heart disease and cancer remain the two leading medical’ causes of death in America.  Benaroch explains two case studies that reveal the symptoms of heart disease and cancer that might be missed with poor diagnosis.  A patient that is overweight, frequently falls asleep, feels tired all the time, snores loudly when sleeping, and has slightly swollen feet arrives at the doctor’s office with his wife.  The diagnosis begins with the patient’s complaint of feeling tired all the time and falling asleep at work.  From that complaint, a physical exam reveals swollen feet.  Tests for kidney and liver malfunction are done to determine a cause for the swelling. They are negative (meaning they were functioning within normal guidelines).  By systematic elimination of causes for swollen feet, the case leads to a diagnosis of congestive heart failure.  The patient is told to lose weight to mitigate the symptoms of his disease.  Being overweight aggravated his heart condition because it required the heart to work at maximum capacity at all times.  As the patient’s health improved, he would be a candidate for gastric bypass to keep his weight under control and reduce the burden placed on his heart.

In the cancer case study, a patient complains of fatigue and has a slightly elevated heart rate even though she is an athlete.  The complaint of fatigue leads to an extensive investigation of family history, revealing cancer as a possible genetic marker.  Further tests show an advanced cancer is present.  Chemo and aggressive radiation treatments are chosen by the patient to slow the cancer’s spread with the hope of remission.  The patient dies.  The point in both the heart and cancer cases is that proper diagnosis is based on what the patient says is the problem.  Though a patient complaint may appear as a minor diagnostic issue, the explanation of what was bothering them led to the right diagnosis and an appropriately prescribed course of treatment.  There are no guarantees for healthful results from medical treatment, but if the diagnosis is wrong, medical treatment becomes irrelevant.

Benaroch’s last lecture in the series is about dementia.  Over the age of 80, some level of dementia occurs in 50% of the population.  In spite of this grim statistic, Benaroch argues that the same rigorous diagnostic procedure should be adhered to with older patients as with all others.  Though older patients are often under the care of their children or by an assisted living’ guardian, listening to what a patient or his guardian is saying must be rigorously tested against standard diagnostic procedure.  The patient he describes in this last chapter is found to have some characteristics of advancing dementia but the level of deterioration is exaggerated by over medication.  Without having followed Benaroch’s standard diagnostic procedure, the patient’s care would have been unreasonably restricted.

Benaroch’s lectures explain the importance of systematic medical diagnosis, emergency medical procedures for non-medical bystanders, and common medical maladies of the 21st century.  His lectures reinforce the importance of listening to patients.

Benaroch recommends using medical tests to diagnose based on what a patient complains of, and treatment of those conditions that cause the symptom.  For proper diagnosis, Benaroch suggests listening to the patient, physical exam, careful histories of patients’ health, records review of past medical conditions, medical tests based on systematic diagnostic procedure, and counseling for patients before and after prescribed treatments.

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