Cover

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Half Title, Title Page, Copyright, Dedication, Quotation

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Contents

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pp. ix-x

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Introduction: Applying and Breaking the Rules

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pp. 1-6

I am an infectious disease doctor. I treat people who are sick with diseases that spread from one person to another person or, in some cases—such as swine flu—from an animal to a person. In the forty years since I took the Hippocratic Oath, the medical world has been transformed through breathtaking advances in medical science. ...

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Rule 1: If You Don’t Know What You’re Doing, Don’t Do Anything

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pp. 7-14

Gladys Worthington, a 76-year-old retired schoolteacher, woke up one morning with the worst headache of her life. When it persisted into the evening, her daughters took her to the local hospital. Although she had been the picture of health for her entire life, she now had a temperature of 101.8 degrees and was markedly confused: ...

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Rule 2: If What You’re Doing Seems to Be Working, Think about Continuing It

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pp. 15-22

Like many Minnesotans, Ted Schmidt, a 48-year-old farmer from Pipestone, spent his winters in Arizona. Unlike most Minnesotans, however, he traveled with someone else’s kidney. Because of chronic kidney failure caused by glomerulonephritis, he had received a kidney transplant at the University of Minnesota Medical Center three years earlier. ...

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Rule 3: If What You’re Doing Doesn’t Seem to Be Working, Think about Doing Something Else

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pp. 23-30

One morning, 7-year-old Molly Aronson awoke with pain in her right hip. Understandably, her mother was very worried, especially when Molly developed a shaking chill and felt, to her mother’s touch, as if she were burning up. She also limped because her pain was so severe. ...

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Rule 4: Don’t Agree to an Invasive Procedure without Understanding Why It’s Needed—and without Getting a Second Opinion

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pp. 31-40

When Awa Fahia, a 28-year-old immigrant from Somalia, arrived in Minneapolis, she had never seen snow and was not prepared for temperatures well below zero. However, with the help of family members already acclimated to Minnesota, she made the best of it. ...

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Rule 5: If You Don’t Have Symptoms, a Doctor Can’t Make You Feel Better

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pp. 41-48

Thelma Moore, an 88-year-old grandmother, developed a high spiking fever and an angry-looking rash over her entire body. She had recently been treated at our hospital for a stroke, and her hospitalization was complicated by pneumonia. Also, she had lost control of her bladder, and a catheter was inserted. ...

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Rule 6: Never Trust Anyone Completely, Especially Purveyors of Conventional Wisdom

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pp. 49-56

Phillip Peterson, a 65-year-old American physician, developed shaking chills while standing at a hotel registration desk in Bangkok. The shaking was so violent that his wife thought he was having a seizure. Phil and his wife had just finished two weeks of travel in Vietnam and Thailand with two friends and had arrived that afternoon in Bangkok. ...

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Rule 7: Most Things Are What They Seem to Be, Except When They’re Not

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pp. 57-64

Roberto Sanchez was an 18-year-old star high school athlete—captain of the football team. He played basketball and lifted weights. Since graduation he had been working in a lumber yard. When he was admitted to our hospital several months after graduation, he couldn’t walk up a flight of steps because of fatigue and difficulty breathing. ...

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Rule 8: What Your Doctor Doesn’t Know Could Kill You

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pp. 65-72

Judging by the many family members and friends who visited the hospital when Pamela Ferguson died, she was greatly loved. Her death came as a shock to everyone. She was only 38 years old. Except for obesity, she enjoyed good health until two days before her hospitalization. ...

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Rule 9: Timing Is Everything, and Sometimes Time Is the Cure

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pp. 73-80

Paul Kreitzler, a 43-year-old musician, was admitted to our hospital complaining of two days of severe lower back pain, fever, and shaking chills. He was known to have metastatic cancer of the anus, diagnosed five months earlier. Also, for the past year he had been taking a combination of antiviral drugs, called highly active antiretroviral therapy (HAART), ...

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Rule 10: Caring Is Always Important Medicine

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pp. 81-90

When she called me, Dr. Allison McGowan had recently celebrated her forty-fifth birthday. I had lost contact with her for about ten years, so it was nice to hear her upbeat voice again. Sadly, however, I learned that she was still suffering from chronic fatigue syndrome (CFS). ...

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Epilogue: The Participatory Art of Medicine

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pp. 91-94

In this book, you’ve read about how doctors arrive at a diagnosis by listening to a patient describe his or her symptoms and looking for signs of disease on physical exam and in laboratory tests. ...

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Recap: The Rules Revisited

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pp. 95-100

I don’t expect you to remember all ten of the Rules. But when you are making a medical decision for yourself or someone you care about, the list below may be useful as a quick reminder. This list will help you choose the Rule or Rules you need in a specific situation and provide a recap of the key thinking behind each Rule. ...

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Acknowledgments

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pp. 101-102

This book wouldn’t have come about if it weren’t for three kinds of people: generators (health care professionals and patients who helped create the Rules), facilitators (experts who helped with the writing), and tolerators (family members who put up with this project). ...

Appendix. Additional Information about the Common Illnesses Discussed in This Book

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pp. 103-130