How do we behave after the diagnosis?

An engrossing and humane read by a doctor/patient


I’m reading a book I love – After the Diagnosis written by kidney specialist, MD Julian Seifter.

Doctor Seifter has diabetes himself, and so shares his own actions, or rather inactions, (he’s a notoriously bad patient the first several years) but it’s really in the background of this book. 

The book’s focus is the stories of his patients. Since all his patients live with kidney disease and generally face the unpleasant, yet only life-saving measure of dialysis, they each face life-altering decisions and are in different stages of their conditions. Seifter relates their stories, their journeys and how they prevail.

It is a fascinating look at the human spirit, and for me made all the more interesting told by a physician whose first orientation is clinical. Yet, he is deeply human and not afraid to share that side of himself with his patients; this often becomes the key for his patients to take the next step they might not otherwise. 

Here is a short bit from the book


Dr. Seifter meets Lyla, a young West Indian woman, who has end stage renal disease, diabetes and AIDs. Lyla went missing after her first dialysis appointment where she was prepped for future treatment. When Seifter next sees her he asks how her blood sugars are. She doesn’t know. They take out her meter and he helps her test, which she doesn’t know how to do. 183, “That’s not so bad,” he says. And then he realizes he has not put on gloves and this is probably the first time in years Lyla has had blood taken without someone wearing gloves. Seifter thinks of referring her to the dietitian, but does not when he thinks how culturally-insensitive she is. She will only hand Lyla the same standard diet she hands everyone. Instead he asks Lyla what she eats. When she tells him rice, beans and potato chips he asks her to match her carbohydrates with protein and make her portions a little smaller. He asks next how she’s feeling about dialysis, “I’ll try it,” she says.

Connecting with the patient, not the illness, is one of a physician’s greatest tool. Yet, it is not what’s emphasized in medical school In fact, I recently spoke with a physician who told me in a way humanity is trained out of  medical students. 

This book is written for patients and physicians alike. There are the stories and interwoven many of Dr. Seifter’s insights. For instance Seifter encourages doctors to help their patients be more imaginative and playful when considering treatment options. Doctors, he says, are instrumental in giving patients confidence, even permission, to keep going. If a doctor, for instance, doesn’t clearly encourage treatment a patient may hear, “Don’t do it!” 

If this is your cup of tea, as it is mine, you will take away a great deal fromAfter the Diagnosis

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