An Infectious Disease Doctor

What It's Like To Be... with Dan Heath

This episode of 'What It's Like To Be...' features Dr. Bahuma Tatanji, an infectious disease physician at Emory University, who shares her exp

Key takeaways

• Infectious disease doctors rely more on thorough patient histories than lab tests or imaging to solve complex cases.
• Many rare diagnoses stem from forgotten exposures decades ago, such as childhood contact with tuberculosis patients.

Main topics

• Diagnosing rare infectious diseases through patient history
• The importance of specific, detailed questioning in medical diagnosis

Notable quotes

"I'm with ID and I'm here to help figure out what's going on with you. And I'm going to ask you some really unusual questions. Are you okay if I do that?"

"You know, we like to describe ourselves as detectives of sort."

Conclusion

Being an infectious disease doctor is less about high-tech tools and more about deep

Transcript preview

Speaker 2 (0:00) Dr. Bahuma Tatanji is an ID doctor. ID stands for infectious disease. Speaker 3 (0:06) I really enjoy the first moment when I walk into a patient's room. particularly when it's a case where nobody knows what's going on. And I introduce myself and I say, I'm with ID and I'm here to help figure out what's going on with you. And I'm going to ask you some really unusual questions. Are you okay if I do that? Speaker 2 (0:33) She's often trying to solve medical cases that other doctors couldn't crack. Speaker 3 (0:38) We always say you really know it is an exotic case when you get the call and they tell you, oncology and rheumatology are already seeing this patient and now we're consulting infectious diseases. Because it usually tells you this is a case that no one really knows what's going on. Speaker 2 (0:58) And her primary tool is not blood work or imaging. It's conversation with the patient. Speaker 3 (1:07) known for our ability to take really, really thorough histories and get in-depth information, which usually helps make the diagnosis in challenging cases. Speaker 2 (1:19) So you're almost like a diagnoser of last resort or something. Speaker 3 (1:24) Yeah, Speaker 4 (1:25) I would say that, Speaker 3 (1:26) you know, we like to describe ourselves as detectives of sort. Speaker 2 (1:31) And like any detective, she's got questions. Speaker 3 (1:34) Our main tool as infectious diseases physicians is actually speaking to the patient and examining them and trying to piece together the pieces of the puzzle. How does this thing that they just told me fit into what I'm worried they might actually have as a disease process? Speaker 2 (2:05) I'm Dan Heath, and this is What It's Like to Be. In every episode, we walk in the shoes of someone from a different profession. A forensic accountant, a hospice nurse, a conductor. We want to know what they do all day at work. Today, we'll ask Dr. Bahuma Tatanji what it's like to be an infectious disease doctor. We'll talk about the wildest cases she's encountered, what's absurd about the TV character Dr. House, Speaker 2 (2:35) the time she encountered a suspected case of Ebola. Stay with us. Speaker 4 (2:46) Hey, it's Anna Sale, host of Death, Sex and Money, the show from Slate about the things we think about a lot and need to talk about more. Many of us have something going on behind closed doors. Like a listener we called Elizabeth, who told us she's a hoarder. I see mess Speaker 3 (3:03) beyond probably what most people think of when they think of mess. Speaker 4 (3:09) We'll work through it all together on Death, Sex and Money. Listen wherever you get podcasts. Speaker 2 (3:17) To get a feel for Dr. Tatangi's work, let's take an example. A patient, middle-aged, is admitted to the hospital. Speaker 3 (3:25) They've been having a fever for three weeks. They've just returned from travel from Asia. And they have been on antibiotics and nothing is better. They have a rash. Can you come help us figure out? what's going on. Now, that's a case where I'm going in with no idea of what's actually happening with the patient. All I have is maybe their age, where they traveled to, and the fact that they have a fever and a rash. Now, if you were to put those cluster of symptoms or clues into a Google search, it would probably generate a hundred differential diagnosis. Speaker 2 (4:04) So a differential diagnosis is basically every plausible thing this particular ailment could be. It's almost like a list of suspects, and she's got to start crossing suspects off the list. And the early focus isn't so much on finding the highest probability suspect. It's more like eliminating the highest danger options, the ones you can't afford to miss. And the ID doctor's key tool? is the patient history. Speaker 3 (4:34) Really what we are focusing on when we take the history is things like what the patient's hobbies are, where they've been, Speaker 2 (4:44) where Speaker 3 (4:45) they've traveled, who is at home with them, what they've been exposed to. And we do that in a manner that is quite systematic and methodical, which is usually why we're able to catch things that others may not. have caught, even though they would have spoken to the patient. Sometimes even multiple teams have seen the patient before infectious diseases comes in. I'll give you a specific example. It's very common when I'm thinking about tuberculosis being part of the differential. What I see is sometimes people don't go far back enough. You might have a patient who is an octogenarian. And no one thinks to ask them, when you were a little child, do you recall living in a house with someone who was being treated for TB? Or do you recall a grandparent who was away, say, for instance, in a sanitarium receiving treatment for TB? So that's a lot more specific than asking them very vaguely, do you have any TB exposures? Because for something like tuberculosis, an exposure that you had 40 years ago, because it's Speaker 2 (5:57) a Speaker 3 (5:57) bacteria that can hide in the body and get reactivated or active many decades later, the exposure may have happened decades before the person is presenting with that infection. Speaker 2 (6:11) Wow. So it can just sort of stay dormant for decades at a time. Absolutely. She often gets oddly specific with her questions. So she won't just ask, have you traveled to a foreign country recently? If they have, she'll follow up with, Did you go Speaker 3 (6:30) into a cave? Are you a bat fanatic? Did you go exploring bats? Did you swim in any local lakes and eat any of the local foods? Was any of that... partially cooked or raw? If you went on a retreat and were in a shaman retreat, what sorts of concoctions were you ingesting during your time there? And these are just things that people don't really delve as deeply into. And if you don't ask these specific questions, sometimes the only thing that jugs that person's memory is to be asked the question. Speaker 2 (7:09) Dr. Chetanji had a case where a patient came in with a fever. No one could figure out why. The patient seemed to be doing okay with the fever, but the person was immunocompromised, which raised the stakes. So the medical team had reached out to Dr. Tatange for a consultation. Speaker 3 (7:27) And I go to see this person, and in taking the history, one of the things that I had noted about their lab work was that they had changes in their blood work that's usually indicative of a mild inflammation of the pancreas, which we call pancreatitis. And sometimes one of the very rare causes of this is being bitten by a scorpion. So I walk into the room and I'm talking to this patient and I specifically ask them, have you been beaten by a scorpion recently? And they immediately said, yes, that happened about two days before I came into the hospital. Oh, Speaker 1 (8:07) wow. I Speaker 3 (8:07) crushed it and I actually have a picture. And they pull out their phone and they show me a picture of the scorpion. I walk out of the room and I tell the team, I don't think this is an infection. I think this is scorpion bite-related pancreatitis. And you all are doing the right thing. Supportive care is enough. And my colleagues asked me, why on earth would you ask someone specifically if they've been beaten by a scorpion? And, you know, so we had this very fun exchange where I think there was some frustration on their part that they had not asked the question. And the patient had been asked if they've had any insect bites recently. But people don't always think about a scorpion as an insect. It's kind of like a lot more specific. It's its own thing, right? And it took asking the specific question to be able to elicit the