The 620-page book is packed with information on common-and not-so-common-diagnostic procedures. It includes detailed, understandable descriptions; easy-to-scan charts, and clear illustrations. Each of its 29 chapters is written by a Yale School of Medicine full-time faculty physician who specializes in the field being covered.
"The book helps patients through the diagnostic process; it lets them and their families know what the process is, what to expect, how to prepare," says Barry L. Zaret, M.D., the book's senior editor. "We want to demystify the process and help patients to be a greater part of that process," adds Dr. Zaret, the Robert W. Berliner Professor of Medicine and chief of cardiovascular medicine at Yale University School of Medicine. He also was an editor of the well-received Yale University School of Medicine Heart Book, published five years ago.
"There's an enormous amount of uncertainty about testing," says Dr. Zaret. Patients wonder, just how does this test work? Is it okay to eat first? How long will the test take? Will it hurt? What will it tell the doctor?
The new book addresses these concerns and more. "It looks critically at the advantages and disadvantages of each procedure and lets people know the next step," says Dr. Zaret. The book also gives people a basis for asking questions, making decisions, and getting exactly what they need-at a time when some critics argue that doctors order too many tests, while others say that with managed care, not enough testing is done in some cases.
The book's first section covers topics important to all readers. It discusses patients' rights and informed consent, examines the role of screening, and provides overviews of current diagnostic imaging techniques (like CT scans) and laboratory tests, from finger-stick blood tests to bone marrow biopsies. The second section deals with testing as it relates to specific organs, organ systems or diseases, or to groups of people, such as children or women.
The physician authors explain how particular systems work, what happens when they don't work right, what doctors look for, and how they go about looking. They include short case histories, describe common disorders, and list signs and symptoms that indicate problems.
Tests are presented in a logical sequence, from the simplest to the most complicated, Dr. Zaret notes. Newer tests-often, more specific or less invasive than older ones-are regularly pointed out.
Charts supply basic information, like where the test is done, how long it takes, what equipment is used, what discomfort or pain may occur, what risks or complications may be involved, and the average cost (lower than $100, $100 to 500, or more than $500). Concise entries cover such important points as the purpose of the test, how the test works, how the patient should prepare, what the procedure entails (step by step), what factors could affect the results and how the results are interpreted.
Throughout the text are helpful illustrations and short items entitled Patient Tips or Did You Know? Illustrations in The Heart show the heart itself, a person getting an electrocardiogram, and two electrocardiogram readings-one normal, the other taken during a heart attack. Tips in The Digestive System include advice on swallowing an endoscope more comfortably; a Did You Know? brief in Rheumatoid and Musculoskeletal Disorders tells just how pathologists evaluate the rate at which calcium is absorbed in our bones. An appendix covers home tests, like monitors for blood sugar in diabetes patients.
"The book is very comprehensive," says Dr. Zaret, "and it's designed to be exquisitely reader-friendly."
On chapters in The Yale University School of Medicine Patient's Guide to Medical Tests (Houghton Mifflin Co., Boston and New York, 1997):
Patients' Rights and Informed Consent deals with the right to understand what's happening and with issues like privacy.
The Role of Screening discusses the benefits and risks of screening, describes common screening tests, and lists questions that can help patients and their families to make decisions.
Diagnostic Imaging explains the workings and uses of X-rays, computer tomography (CT) scans, nuclear scans, positron-emission tomography (PET), ultrasound tests, magnetic resonance imaging (MRI) and arteriography.
An Overview of Laboratory Testing notes the uses of dozens of tests, discusses the interpretation of results, and reports on new diagnostic technologies like flow cytometry.
The Heart lists common cardiovascular problems, notes symptoms of those problems, and describes procedures ranging from electrocardiograms (several varieties) to cardiac catherization.
The Respiratory System includes information on the peak flow measurement test that people who have asthma can do to monitor themselves.
Diabetes explains why the disease produces the symptoms it does. It includes laboratory tests used to diagnose and monitor diabetes, as well as procedures that evaluate complications of the disease.
Testing in Infants and Children describes ways in which testing may differ for youngsters and offers helpful tips for parents.
Testing in Women includes information on mammography, breast ultrasound, breast biopsies and bone-density studies.
Sports Medicine offers tips for preventing sports injuries and descriptions of particular procedures, like the KT-1000 which uses a machine to test injured knee ligaments with the application of force.
Other chapters deal thoroughly with testing related to the vascular, digestive, endocrine, renal, nervous and immune systems; the circulatory and lymphatic systems; the male and female reproductive systems; pregnancy; allergies; rheumatoid and musculoskeletal disorders; the skin; the sensory organs; hypertension; HIV and AIDS; infectious diseases; genetic diseases, and toxicology, the monitoring of drug therapy, and testing for substance abuse.
About the editors (all Yale University School of Medicine faculty): The senior editor, Barry L. Zaret, M.D., is Robert W. Berliner Professor of Medicine, professor of diagnostic radiology, chief of cardiovascular medicine, and associate chair for clinical affairs (internal medicine). The associate editors are Peter L. Jatlow, M.D., professor and chairman of laboratory medicine, and Lee D. Katz, M.D., associate professor of radiology and director of diagnostic imaging.