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Rewrite of New York Times' Scientific Article "The Instincts to Trust Are Usually the Patient's" by Sandeep Jauhar, M.D.

Rewrite of New York Times' Scientific Article "The Instincts to Trust Are Usually the Patient's" by Sandeep Jauhar, M.D.

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Published by Karyn N. Lewis
Science Article Rewrite assignment in association with 0502-460-70 Science Writing - Rochester Institute of Technology Winter 2008
Science Article Rewrite assignment in association with 0502-460-70 Science Writing - Rochester Institute of Technology Winter 2008

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Published by: Karyn N. Lewis on Jan 22, 2009
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05/10/2014

Karyn N.

Lewis 0502-460-70 Science Writing Assignment #2 Winter 20082

Rewrite of New York Times’ Scientific Article “The Instincts to Trust Are Usually the Patient’s,” by Sandeep Jauhar, M.D.

Every year, millions of Americans fall prey to real-life medical mysteries—ailments that go undiagnosed or misdiagnosed for years—because their instincts are questioned. Their lives are thrown into turmoil and sanity called into question as medical professionals struggle to understand their baffling conditions. Remarkably, some patients know they are about to die even when no one else does. This is the situation Long Island cardiologist Sandeep Jauhar, M.D. recently faced when taking care of an elderly man with congestive heart failure—a lifethreatening condition in which the heart can barely pump enough blood to the rest of the body. The case of Jauhar’s patient seemed relatively mild up until his health took a sudden and rapid turn for the worse. His massively swollen legs dripped enough fluid to soak the bed sheets and puddle on the tiled floor, his blood pressure dropped dangerously low, and he became delirious. After just a few days’ stay, the man was certain he wouldn’t make it out of the hospital alive. “I am going to die here,” he whispered, as if all of a sudden attaining the alleged predictive powers of Nostradamus and realizing a crystal-clear picture of the future. Roughly 550,000 people are diagnosed with heart failure each year according to the Centers for Disease Control and Prevention (CDC), making it the leading cause of hospitalization in people older than 65. Congestive heart failure usually develops gradually, however, with an exceptionally slow onset and progression of symptoms over time. In some cases, the heart becomes too weak or stiff to fill and pump efficiently, impairing the ventricles’ capacity to relax and fill. The kidneys respond by triggering the body to retain water and sodium, causing a build-up up in the arms, legs, ankles, feet, lungs, or other organs.

The treatments used to help improve the function and ease the workload off the heart of Jauhar’s patient—lifestyle changes, medicines, transcatheter interventions—just didn’t work. Strangely, nothing seemed to work. Symptoms emerged, tests were analyzed, and specialists were consulted, but several days passed and the struggle continued. Jauhar was perplexed by his patient’s precipitous downturn and the lack of treatment success. “It was as if I was living in a nerve-wrenching episode of Mystery Diagnosis and experiencing first-hand a step-by-step medical odyssey—excluding the highly stylized recreations and CGI anatomy sequences,” he observed. Instead of the typical Mystery Diagnosis plot of solving the puzzle due to the patient's relentless pursuit of an accurate and final diagnosis, however, the man died. This “real-life” version of the popular TV drama did not have a happy ending. In his work as a critical care cardiologist, Jauhar is often asked to predict how long someone is going to live. Such projections can be useful to patients and their families, but the doctor rarely, if ever, ventures a guess. “My guesses are so often inaccurate. It simply amazes me when patients have a sort of sixth sense about their own deaths,” he remarked. “It’s almost like they feel the impending doom of a catastrophic event about to occur, akin to the Apocalypse and Armageddon obsession, Doomsday hysteria, or Millennium madness. Somehow they are just certain the end is near, whether the Big One hits, UV rays fry the Earth, a nuclear winter freezes over, the Earth opens up to swallow us all, or heart failure seizes their final breath.” When discussing instinct in medicine, people typically refer to doctors grasping diagnoses in ways that seem to defy analytical explanation in knowing, almost intuitively, which data to focus on and which to ignore. We assume their decision-making is based on experience and deductive reasoning or evidence, yet it seems almost mystical. Jauhar explains, “I will never forget the time in medical school when we presented a baffling case to the chief of medicine, who made a diagnosis of primary pulmonary hypertension within seconds on the basis of the

sound of the patient’s heartbeat—an incredible feat of observation and logical synthesis.” Just as mystifying is the rarity in which this sort of diagnostic intuition actually occurs. Patients today often receive a battery of tests even before a physician examines them. The results—usually expressed in numbers that give misleading impressions of absolute precision— tend to lull doctors into a sort of laziness that has atrophied instinct. Jauhar comments, “We would serve well to base our theories of a patient’s illness on subtle or controversial insights like Hugh Laurie does in House—hold the acerbic, brutally honest and pretentious demeanor.” Medicine is often more of an art than a science, and the journey to diagnosis can be a twisted path full of many surprises. Not all doctors can become brilliant diagnosticians whose unconventional thinking and flawless instincts afford them a great deal of respect. “I have learned that the best instincts in medicine derive from the patients themselves. Their intuitions about their own health may be denigrated by doctors, but we must learn to pay attention to them,” Jauhar notes. “Patients’ instincts often hold the vital clue.”

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