personnel face similar challenges in collecting reliable data to reduce uncertainty and sharpen diagnoses. He reveals how the methodologies and practices he employed so successfully in the US Intelligence Community can also help fill data gaps and contribute to a more complete and accurate medical diagnosis. In this book, he methodically lays out practical prescriptions for prevention, response, and recovery.
Both of us were avid runners who prided ourselves on staying in shape to meet the demands of our often-stressful work. Yet we both surprised ourselves and shocked our families and friends by having life-threatening medical conditions. Randy’s story, typical of an intensely curious analyst with a healthy bent toward skepticism, is about his forceful challenge to medical experts. The experts believed they had a better grasp of available data on his evolving diagnosis than he did—and turned out to be wrong.
My story parallels Randy’s in many ways. It begins with my own failure to question flawed assumptions about the correlation between apparent good health and immunity from heart disease. I was an in-shape nonsmoker, a sensible eater with no significant family history of diabetes or heart disease. With eight marathons under my belt, I continued to jog regularly, swim every day, and play tennis twice a week. I thought I was in top condition until I almost died from a heart attack after a stressful day in the rugged hills of western Croatia. Unlike Randy who took charge of his medical care, I blame myself for not working with a primary care physician to monitor a growing blood pressure problem related to cholesterol. The alarming data would have been discovered had I sought it—what we sometimes refer to as an “unknown known.”
The author’s recommendations flow from the basic admonition to take charge, be a proactive participant in your diagnosis and treatment, listen attentively to your own body, ask your doctors every hard question that comes to mind, express doubts when you have them, take notes to help organize and prioritize your issues and concerns, collect your own data to fill inevitable gaps, and keep a data-rich account of your medical history. Above all, never settle on being a passive consumer of your medical data or a silent observer of medical systems and practices. You should interact constantly and vigorously with your doctors and other medical personnel.
In closing, I would like to offer two personal observations related to emotions that go beyond the usual medical discussion of innovative medical procedures and pathbreaking drug therapies. Lots of empirical evidence speaks to the wider relevance of my issues to health. The first is the role of stress in elevating the chances of a heart attack and slowing recovery. This is not that complicated. I know from personal experience that we simply can and should learn to reduce the stress in our lives as an investment in good health. Second is the impact of human relationships. From the moment I arrived at a Croatian ICU, I believed I could and would get better. I was kept grounded with high morale by the constant reassuring presence of my wife, Mary Ellen, and by the loving support of our children, grandchildren, and close friends. These folks were a powerful driver in my survival and recovery. I’m not sending a Hallmark card here. I’m providing hard data you can take to the bank. Investment in people pays rich dividends!
The good news for Randy and me is that the excellent medical procedures and continuing care we received in the same Northern Virginia hospital, our healthy diets, our regular physical exercise, and our robust network of close family and friends have boosted our resilience and speeded our recovery, turning a brush with death into a wake-up call—a second chance for a long, active life with the people we love. We are still here to tell our stories. We are lucky guys, and we know it!
Randy Pherson made himself a proactive participant in the diagnosis and treatment of his condition and, ultimately, in saving his own life. This gripping story and the sound advice he offers are certain to help others take charge of their health care. We all should take his good advice to heart!
John Gannon
Former Chairman, US National Intelligence Council
Falls Church, Virginia
January 8, 2019
The sun was shining on a crisp day in March 2014 as I headed for a meeting at the State Department. After parking my car in a nearby garage and walking just a few blocks, I began having trouble breathing. Because I was a runner, I was perplexed to find myself out of breath. I rested for a few minutes and then proceeded to my meeting. That was Friday. On Monday, I went to see my doctor, who said, “I’m not sure what is wrong, but you need to go to the emergency room.” I told her I had some meetings later that day but could work in a visit on Tuesday. My doctor said, “No. I mean now, not tomorrow. We have two world-renowned hospitals within a few miles of my office. Pick one and drive there.”
I chose the hospital where my son was born, and it was a good decision. When I arrived at the emergency room later that morning, I waited for less than an hour. A nurse interviewed me, and the doctor decided to give me an EKG to check out my heart. The results came back quickly, and the cardiologist on call said,
“Your heart looks fine. Go home and rest.”
“No. I need to know what is wrong,” I responded.
The doctor took another look at my files, asked me some more questions, and said, “I really don’t see a problem; I am releasing you.”
“No,” I responded. “I will not leave until you can offer me some alternative hypotheses for what is wrong with me. I also want to discuss what assumptions you are making and whether they are valid.”
The cardiologist was not used to patients making such arguments, but realized he was talking to a career CIA analyst who had written books on critical thinking and Structured Analytic Techniques. So, he relented and admitted me for an exploratory procedure the next morning. He said I had “worn him down” to the point he would authorize the procedure despite a mild risk factor. He said he was “90 percent certain” they would find nothing wrong on Tuesday.
My wife came to visit and asked a nurse if she should arrange for my son to drive my car home. She was told by the nurse that the procedure was scheduled for late morning and that I should have no problem driving myself home later that afternoon because I would be awake during the entire procedure and could even watch it on a computer screen.
They did the procedure Tuesday morning, but I did not go home that day. Instead, I was scheduled for major surgery Wednesday morning. Because of that surgery, I am alive today.
Why This Book?
I was a victim of medical misdiagnosis, and I am in good company. According to a report issued in 2015 by the Institute of Medicine, an arm of the National Academy of Sciences, as many as twelve million Americans may be receiving erroneous or late diagnoses every year.1 This is far more than the estimated hundred thousand deaths per year attributed to errors in hospital treatment. Moreover, the error rate for diagnosing illnesses is likely to worsen as the diagnostic process and health care delivery become more complex.
I began my search for a diagnosis when I started having trouble breathing while running in 2010. It took five years before I finally got a diagnosis following my visit to the emergency room. Over that five-year period, I sought and received treatment from a dozen doctors representing six different specialties—all of whom failed to identify what was causing my problem. I asked many questions during that time and learned a lot about how poorly—and at times, how well—the medical care industry functions in the United States. I condensed these experiences into sixteen actions you can take to improve the quality of your health care:
• Five questions you should always ask your doctor.
• Five obstacles you should
