Lessons from a Deadly Dinner Party: the Importance of Medical History

Author Jonathan A. Edlow, MD book cover

Lessons from a Deadly Dinner Party: the Importance of Medical History

Author Jonathan A. Edlow, MD book coverDr. Jonathan A. Edlow is a specialist in tick-borne diseases and neurological emergencies at Beth Israel Deaconess Medical Center whose investigations deal with misdiagnosis of neurological emergencies. Thrilled as a teenager by medical mysteries and mystery stories in general, he became long ago a collector of medical mysteries. Eventually, he ended publishing some of those stories in popular magazines; and now, in ‘The Deadly Dinner Party’ (Yale University Press, 2009) he has compiled them in a well structured volume where the culture of medicine, at least in the western world, is exposed with all its power, flaws, and needs, both at the level of physician-patient interaction and at the institutional level on public health concerning large epidemiological outbreaks and their prevention.

A fun book to read, it works wonders as an introduction for international interpreters, especially those fairly newcomers to the western culture of medicine. It may also help to enhance an already established acquaintance with the system in which we, healthcare interpreters, operate in a daily basis. And since the author takes advantage of the exposed cases and diseases to explain the most up to date currently available diagnostic tests and techniques, it might additionally provide a brush up to medical issues with which, due to their rare occurrence, we do not cross paths often.

The stories are told in a similar pattern, thus providing consistency along the book: a presentation of the case, a brief history of the problem (discovery and evolution of involved treatments in different historical times), a discussion of other archived cases related to the same complaints (including the first recorded diagnoses and physicians involved, if known), and an explanation of the resolution of the case initially presented.

Divided in three sections, the book covers issues where organisms, drugs, and conditions are concern for disease:

I. Human Meets Pathogen

1. Clostridium botulinum van Ermengem, 1896 [Botulism]
2. Salmonella enterica (ex Kauffmann & Edwards 1952) Le Minor & Popoff 1987 Servoar Salmonella typhi [Salmonellosis]
3. Plesiomonas shigelloides corrig. (Bader 1954) Habs and Schubert 1962
4. Pseudomonas aeruginosa (Schröter 1872) Migula 1900
5. Escherichia coli (Migula 1895) Castellani and Chalmers 1919 and HUS (hemolytic uremic syndrome)

II. The External Environment

1. Guillán-Barre Syndrome/ Tick paralysis
2. Thermophilic actinomycetes and hypersensitivity pneumonia
3. Polytetrafluoroethylene (Teflon)
4. Atropine and scopolamine (versus Brain aneurysm)

III. The Internal Milieu

1. Scombroid poisoning
2. Hyperthyroidism (Graves’ Disease/ Thyrotoxicoidosis)
3. Intestinal blockage and bezoars
4. Ascites and Budd-Chiari Syndrome (Plant toxic alkaloids)
5. Papilledema
6. Hypercalcemia

Due to the intrinsic nature of the portrayed stories, they can be independently read, allowing the reader à la carte introduction to a wide range of symptoms and tentative diagnoses concerning multiple epidemiological diseases, some of them involving the Epidemiology Intelligence Service of the Centers for Disease Control and Prevention. The book also hints and provides advisory tips on how to avoid contracting the portrayed infections; therefore, it helps the healthcare personnel to prevent communicating them to other patients. Careful, though, on becoming hypochondriac by starting to see potential sources of infection and disease in everything we touch, eat, and breathe.

Besides informing on several medical subjects and forcing us to think about them from the provider’s perspective, what from the book may be of most interest to us, healthcare interpreters, is the certainty of the immense weight the medical history carries:

In all of these cases, the nature of the problem was not revealed until the doctor eventually unearthed information that had not been offered initially.

“In medicine, we feel about 80 percent of diagnoses can usually be made by the [medical] history alone,” says Setnik. ”Despite all the high-technology tests we have available now, it is still the history that tells you what is wrong with somebody. (…)

In these stories, patients and providers speak the same language and share a similar background culture. However, the interacting parties are basically set apart by their knowledge of the culture of medicine; complete understanding between them is not fully granted:

(…) Four of us, all good doctors, had asked about medication ingestion. But none of us asked the question the right way. The family finally helped us out by asking us directly, ‘what are you worried about?’ That helped us to be more direct with our questions and get to the right answer. My lapsing into medical jargon could have affected the care of the patient. Now I ask the question differently, and I learn more about the patients. In the past when I asked about medications, I’d often hear nothing, either because the patients were embarrassed that they were taking something that had not been prescribed, or just because they didn’t consider some things ‘medications’, such as herbs or other nutritional supplements.”

Consequently, if in cases as such, with patients and clinicians sharing a similar background culture, faithful communication is difficult enough, it is in situations involving patients with limited English proficiency (LEP) where the healthcare interpreter will be most needed.

deadly dinner party graphThe interpreter, acting as a communication conveyor, breaks both language and cultural barriers between patients and clinicians, facilitating a welcoming environment where trust and reassurance are key for the LEP patient to provide a precise, and as complete as possible, medical history; as a result, the interpreter paves for the clinician the road towards an accurate diagnostic conducive to the best treatment plan, the ultimate goal everybody is seeking.  Hence, the interpreter must, at all times, aim to be extremely faithful to the spirit of the original message.

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