What medical mysteries can teach us about getting better health care

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Who doesn’t love a good mystery?

For 15 years, medical reporter Sandra G. Budman has been chasing down the most unusual, weird and wacky medical cases for her monthly Medical Mysteries series. Recent stories have focused on a teenager who couldn’t wake up, a woman misdiagnosed with ALS, and an entire family and guest struck down by a strange flu-like illness.

I caught up with Sandra to find out more about how she writes the column and the lessons we can learn from it.

Here is our edited conversation.

Q. How do you choose your ideas?

A: It must be something I haven’t written about. Must be a resolved case. I need to know the final diagnosis. Although a case is solved, there must be a mystery. And there must be a human story.

Q. Once you select a case, how do you report it?

A: I am asking for a history of events and medical documentation that confirms the diagnosis. The medical records and the chronology allow me to understand if it really is a mystery, if it has developed 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 doctors who are currently treating you. Every step along the way, the process can fail.

Q. Do you write about unsolved cases?

A. No, it must be a resolved case. A lot of people write to me and say, “I have this problem, can you help me?” Unfortunately, I don’t do that. I once wrote about a lawyer in Detroit who had gone to the Undiagnosed Disease Program at the National Institutes of Health. He has been to more than 100 doctors and still no answer. But I thought his case was so unusual and interesting that I made an exception this time.

Q. What are some of the most memorable medical mysteries?

A: I wrote about a family that kept getting recurrent strep throat. They couldn’t understand it. An enterprising veterinarian stepped in. It turns out their cat may be the vector. When the cat was finally treated, no one had strep.

One of the weirder ones – there was a woman with serious kidney and heart problems. Turns out he ate too much licorice. That was really weird.

And I still vividly remember a State Department employee who had a terrible itch on her head at night. She was even tested for a type of cancer. She went to many dermatologists. Turns out she had lice for a whole year. How did they miss that? That was really stunning.

Q. What have you learned about the medical system from writing medical mysteries?

A. Medical care is becoming more specialized. Doctors are aware of a small fraction of what is going on, but diagnosis is inherently a complex process. I also think the time pressure is getting worse. It’s like, “You have 10 minutes. I’m going.” That won’t work with a complex problem.

I also think that sometimes patients are not good at describing problems. People who tend to do better are organized and can describe their symptoms in a way that a doctor can understand.

Q. What is your best advice to patients about getting better medical care?

A. Primary care physicians can really help the patient. I often see people going straight to specialists. They may not have a primary care doctor or use an emergency room when they are sick. This can be problematic. People really underestimate the role of a good primary care physician.

The 2022 Prosperity+ Gift Guide

Need a gift idea? The Well+Being team shared our favorite finds for cooking, exercise, spending time at home, improving our mental health, gifts for your pets, and more.

Some gifts are practical and affordable; others are outright wasters. 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 disabilities, suggested jewelry for hearing aids. Reporter Teddy Amenabar found the perfect travel coffee mug.

There are many to choose from and each item brings us closer to a healthy, fulfilling life. 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 at Thanksgiving. Could this really happen?

While it’s theoretically possible, it’s extremely unlikely that your stomach will explode from overeating, said Sophie Balzora, an associate professor of medicine at NYU Grossman School of Medicine and a gastroenterologist at NYU Langone Health. She writes:

Your stomach is a healthy organ with thick muscle walls and a rich blood supply that can easily withstand even a large Thanksgiving meal.

The stomach also has a remarkable ability to expand 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 is delivered to your stomach, telling it to prepare for food. As you eat, the stomach stretches, freeing up more and more space.

But gastric rupture has occurred. One report involved a 24-year-old female patient who visited an emergency department in Turkey with sudden abdominal pain, vomiting, and nausea after eating an excessive amount of fruit. Abdominal surgery revealed that her stomach was perforated and contained almost five liters of partially digested food, including grapes and pomegranates – apparently far beyond what most human stomachs can handle.

To learn more, read Balzora’s full answer in Ask the Doctor: If I Eat Too Much, Will My Stomach Burst?

It’s been another busy week! Check out these stories from the team.

How Exercise Affects Your Thanksgiving Appetite: High-intensity exercise can dull your appetite for several hours. But regular moderate exercise can make you hungrier.

Inviting pets to a holiday celebration? Know the foods you can and can’t share: Vets offer guidelines for a fun and safe holiday dinner with your furry family members.

9 Tips for Coping with Grief with Kids During the Holiday Season: Check in with yourself and your kids, show some care, and create new traditions.

My mother’s diet 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, especially daughters.

What is the difference between RSV, the flu, and covid-19? Three respiratory viruses strain families and hospital systems. Here are tips from infectious disease experts.

The ‘most common crippling hand condition’ you’ve never heard of: Often, people with Dupuytren’s contracture mistakenly think they have arthritis or tendonitis, or don’t notice a problem until their fingers start to bend.

Why your doctor doesn’t seem to care about you: Many patients define caring as listening, investigating, tracking and advocating for results. That kind of care takes time and resources that many doctors don’t get, says Dr. Shirlene Obuobi.

Please let us know how we get on. Email me at [email protected]

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