A doctor’s passion for medical storytelling
For a Yale alumna, the patient history and physical takes on a new narrative life in The New York Times.
Lisa Sanders, M.D. ’97, HS ’01, loves a good story and has built her career around her narrative skills, beginning with her early days in television and continuing through her subsequent decade in medicine. The form her tales have taken, however, has changed over the years.
A few years ago, when an editor friend asked Sanders what she thought doctors could write about, her answer was that they write one thing and they write it every day: the history and physical. Her belief in the storytelling power of the H-and-P led to “Diagnosis,” a monthly column in The New York Times Sunday Magazine, about cases that stump doctors and how they are ultimately resolved. In Sanders’ hands, the column’s H-and-P format is an effective way of weaving tales about such cases as an emaciated 9-year-old girl who suffered months of vomiting and diarrhea before being diagnosed with Addison disease, or a young man whose Hodgkin disease was diagnosed after frightening episodes of memory loss. The column’s success inspired the TV series House, about a curmudgeonly physician who is a brilliant diagnostician. “Until House came about, diagnosis [in TV medical dramas] was the one-liner between symptoms and the terrible response to treatment. House takes that moment and looks at it, which is what my column did,” said Sanders.
Sanders started her working life not in medicine but in journalism. After graduating from the College of William and Mary in 1979, she worked as a producer at CBS News, where she earned an Emmy Award. By the early 1990s, she was looking for something else to do with her life. She had covered medicine and it had captured her attention. “I thought, ‘This is something interesting.’ If I can do it, it will be fun,” she said. “And it turns out it has been fun.”
In 1992, after two years at Columbia University’s Post-Baccalaureate Premedical Program, Sanders entered the School of Medicine. At age 36 she was the oldest member of the Class of 1996. She completed her internal medicine residency at Yale and became chief resident in 2000.
Since then, Sanders has combined her talent for storytelling with her passion for medicine. She is an assistant clinical professor of medicine at the School of Medicine and teaches in the Yale Primary Care Residency Program at Waterbury Hospital. Sanders believes that when talking with the same patient, different doctors get both the same story and a different story, depending on how comfortable the patient feels and what questions the doctors ask. Eliciting a history is an important skill, she believes, and one she spends a lot of time helping residents develop. She also uses the physical exam to teach residents how to think about and approach problems. Although she occasionally lectures, Sanders feels that medicine isn’t learned that way. “The trick in medicine is not facts,” she said. “The trick is figuring out how to apply what you know to the case at hand. That actually turns out to be a very difficult skill.”
Sanders listens to each person’s story, never spending fewer than 20 minutes with a patient. She specializes in obesity and has plans to set up an outpatient obesity clinic at Waterbury Hospital. Several years ago, while researching low-carbohydrate diets, Sanders realized that adhering to a way of eating, rather than a specific diet, is the key to losing weight. This led to her 2004 book, The Perfect Fit Diet: How to Lose Weight, Keep It Off, and Still Eat the Foods You Love (St. Martin’s Griffin), which offers guidelines on how to devise a sensible eating plan based on personal food preferences.
Sanders lives in New Haven with her husband, writer Jack Hitt, and their two daughters. She fits teaching, consulting, writing and treating patients into her schedule by getting up at 4 a.m. to write for three hours before beginning the rest of her day. In addition to her column, she is working on her second book, The Tools of the Trade: The Art and Science of Medical Mysteries. Scheduled for publication next spring, the book seeks to put the reader into the doctors’ shoes as they negotiate the uncertainty between symptoms and diagnosis. She loves writing because it requires her to step back from the immediacy of treating patients, but medicine is the driving force behind everything she undertakes. As for what her future holds, the ending to that story hasn’t been written yet. “I used to have five-year plans,” she said, “but nothing I’ve ever done has been on them.”