The Myth of Medical Best Practices

The following excerpt from the new book "Your Medical Mind" by Jerome Groopman, MD and Pamela Hartzband, MD is reprinted by arrangement with The Penguin Press, a member of Penguin Group (USA), Inc. Copyright (c) Jerome Groopman and Pamela Hartzband, 2011.

Patrick Baptiste, a thirty-six-year-old personal trainer at a popular health club in Houston, Texas, typically bench-pressed 310 to 320 pounds.

Standing just shy of six feet three inches, with broad shoulders and a neatly trimmed goatee, Patrick had a warm and relaxed manner that made him one of the favorite instructors among patrons of the gym. One day shortly before Thanksgiving, when he positioned himself squarely on the bench to show a new member how to press properly, the weight seemed unusually heavy. Over the ensuing months, his strength seemed to decline, until he strained to press 225 pounds.

Patrick had been eating more than usual to boost his strength and was surprised when he got on the scale and saw that he had lost seven pounds. He looked at himself in the mirror and noticed that the prominent curves of his biceps seemed a little flatter. Even more perplexing were several episodes of rapid heartbeat and trembling in his hands. These episodes occurred not only after he worked out at the gym, but once when he was driving to visit his family on a day off and another time when he was stretched out on his couch watching football. Patrick oft en felt on edge and several times was impatient with clients at the gym. Finally, when he realized that it took effort even to walk up a flight of stairs, he went to see his primary care doctor.

Patrick's physician had cared for him for several years and noted that his pulse, normally in the low 60s typical for an athlete, was now 90. As the doctor examined him, he stopped at his neck. "You have a muscular neck," the doctor said, "so I'm not sure, but your thyroid gland seems a little enlarged. That might explain what's going on here." The physician performed blood tests and called Patrick the next day to say that his thyroid hormone levels were too high. "I'm going to send you to an endocrinologist who specializes in thyroid conditions," the doctor said. "In the meantime, this medication will help with some of your symptoms, and you should start to feel better." He prescribed a medication called a "beta-blocker" to alleviate the tremor and slow the rapid heartbeat. "Before you see the specialist, we'll get a scan of your thyroid. He'll review the results and decide on the best therapy."