So, for example, one thing she encountered over and over when she talked to patients who'd had a diagnostic issue was the problem of time.

They would say, "It took me forever to get a doctor's appointment.

Then I finally got the appointment, and I was in there for maybe ten minutes most with the doctor.

And during that appointment, the doctor was looking at their computer the entire time, typing into it, and I don't feel like they were listening to me, and that's why I think I didn't get the correct diagnosis to start." And then I would go and talk to physicians, and I would say, "From your perspective, what do you think are some of the factors that play into situations where you might have gotten the diagnosis wrong, or you just couldn't quite figure it out?" And I would basically hear the same complaints.

They would say, "I have to see twenty patients in a given day.

I'm only allotted a tiny amount of time.

And during that time, I'm supposed to be typing information into the electronic health record, and I feel like I'm not able to give the patient my full attention," or, "I wish I had more time in that appointment with the patient," or, "I wish I had more time to review that patient's medical record," or, "I wish I had more time to think, to like really sit with the information provided and try to piece it together."

Even if every system does learn from the undiagnosed diseases model, though, and doctors have the time, and the resources, and the coordination to come to a diagnosis, that is just the beginning of the story.

W- how does diagnose actually happen in the real world versus what we imagine?

So I think, you know, sometimes from these TV shows it, it is, you know, s- it, it's like the doctor is some kind of Sherlock Holmesian character, and they're just like picking up on things.

And there are physicians like that, and I have interviewed them, and they're in my book, and they're amazing.

Um, but a lot of what diagnosis is, is physicians or clinicians have basically gone through the very intensive medical training of, you know, in part just pure learning and memorization of how the body works when it's well and how the body works when it's sick and learning about various disease states.

Uh, you know, what, what are the symptoms of heart failure? What are the symptoms of pneumonia? What does a shing- a shingles rash look like? And physicians learn to be very good at seeing a patient, hearing what is sometimes called their chief complaint, so what are they most concerned about, looking at them, seeing sort of the physical signs of disease, listening to, you know, how it's affecting their body, and then really in their mind immediately making this, this list of possibilities, ideally with the most common and likely, uh, diagnosis at the top.And then as you go down the list, they have alternative explanations of what it could be sort of based on, um, what is maybe less common but still a possibility.

And ideally, while they're listening to you, they're sort of combining all this medical knowledge in their mind, and they're reaching like, "Okay, it is most likely that somebody with these symptoms and somebody who is like my patient, age, gender, et cetera," based on what, you know, lifestyle, behaviors, it w- you know, what have you, that they can sort of line up these diagnoses.

And, and they can do it pretty fast.

Ah.

But can you talk about that, the promises of evidence-based medicine, and then its pitfalls and where it fails patients who don't fit the diagnostic criteria, and then what happens to them?

Absolutely.

So, you know, as medicine has gotten more scientific over times through the history of medicine, where you have gone from basically a physician's observations just of the person in front of them to a physician being able to not only listen to your heart and lungs and your chest with something like a stethoscope, to actually being able to peer inside your body with an ultrasound, to being able to sequence a genome.

There's now so many more technical ways to diagnose.

At the same time, what this has meant is that there is now a system in place where when a physician is looking at a patient and wants to diagnose them, often the signs of illness become almost more important than the symptoms.

So what I mean by this is if someone comes in and they say, "I'm having this horrible, burning itching on my neck," and a physician takes that and says, "Okay, there's so many things that could cause an itching sensation." But then if the patient shows them an actual rash, then the physician can say, "I either recognize this.

Perhaps it's shingles." That's like a well-known kind of rash that a physician might see very often.

I loved that whole cast of characters.

And how much of this is also just the broken medical system we have in this country?

Well, one of the most interesting things to me was when I spoke to both patients and doctors for this book, they often cited many of the same frustrations when it came to getting a diagnosis.

They talked about how doctors feel rushed, they're drowning in paperwork, and then patients experience the opposite side of that.

It can be really hard to get an appointment with a primary care doctor.

As soon as you get one, sometimes that appointment feels very, very short and people end up going long periods of time without a diagnosis or they get an incorrect diagnosis.

They end up cycling through ineffective treatments and everybody's frustrated and people don't have relief.

And they've spent Lord knows how much money.

And how about artificial intelligence? How much can it help with diagnosis? There's a lot of talk about how it can really help with diagnosing cancer and other issues.