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How Doctors Think, by Jerome Groopman
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On average, a physician will interrupt a patient describing her symptoms within eighteen seconds. In that short time, many doctors decide on the likely diagnosis and best treatment. Often, decisions made this way are correct, but at crucial moments they can also be wrong -- with catastrophic consequences. In this myth-shattering book, Jerome Groopman pinpoints the forces and thought processes behind the decisions doctors make. Groopman explores why doctors err and shows when and how they can -- with our help -- avoid snap judgments, embrace uncertainty, communicate effectively, and deploy other skills that can profoundly impact our health. This book is the first to describe in detail the warning signs of erroneous medical thinking and reveal how new technologies may actually hinder accurate diagnoses. How Doctors Think offers direct, intelligent questions patients can ask their doctors to help them get back on track.
Groopman draws on a wealth of research, extensive interviews with some of the country’s best doctors, and his own experiences as a doctor and as a patient. He has learned many of the lessons in this book the hard way, from his own mistakes and from errors his doctors made in treating his own debilitating medical problems.
How Doctors Think reveals a profound new view of twenty-first-century medical practice, giving doctors and patients the vital information they need to make better judgments together.
- Sales Rank: #48163 in eBooks
- Published on: 2008-03-12
- Released on: 2008-03-12
- Format: Kindle eBook
From Publishers Weekly
Starred Review. SignatureReviewed by Perri KlassI wish I had read this book when I was in medical school, and I'm glad I've read it now. Most readers will knowJerome Groopman from his essays in the New Yorker, which take on a wide variety of complex medical conditions, evocatively communicating the tensions and emotions of both doctors and patients.But this book is something different: a sustained, incisive and sometimes agonized inquiry into the processes by which medical minds—brilliant, experienced, highly erudite medical minds—synthesize information and understand illness. How Doctors Think is mostly about how these doctors get it right, and about why they sometimes get it wrong: "[m]ost errors are mistakes in thinking. And part of what causes these cognitive errors is our inner feelings, feelings we do not readily admit to and often don't realize." Attribution errors happen when a doctor's diagnostic cogitations are shaped by a particular stereotype. It can be negative: when five doctors fail to diagnose an endocrinologic tumor causing peculiar symptoms in "a persistently complaining, melodramatic menopausal woman who quite accurately describes herself as kooky." But positive feelings also get in the way; an emergency room doctor misses unstable angina in a forest ranger because "the ranger's physique and chiseled features reminded him of a young Clint Eastwood—all strong associations with health and vigor." Other errors occur when a patient is irreversibly classified with a particular syndrome: "diagnosis momentum, like a boulder rolling down a mountain, gains enough force to crush anything in its way." The patient stories are told with Groopman's customary attention to character and emotion. And there is great care and concern for the epistemology of medical knowledge, and a sense of life-and-death urgency in analyzing the well-intentioned thought processes of the highly trained. I have never read elsewhere this kind of discussion of the ambiguities besetting the superspecialized—the doctors on whom the rest of us depend: "Specialization in medicine confers a false sense of certainty." How Doctors Think helped me understand my own thought processes and my colleagues'—even as it left me chastened and dazzled by turns. Every reflective doctor will learn from this book—and every prospective patient will find thoughtful advice for communicating successfully in the medical setting and getting better care.Many of the physicians Dr. Groopman writes about are visionaries and heroes; their diagnostic and therapeutic triumphs are astounding. And these are the doctors who are, like the author, willing to anatomize their own serious errors. This passionate honesty gives the book an immediacy and an eloquence that will resonate with anyone interested in medicine, science or the cruel beauties of those human endeavors which engage mortal stakes. (Mar. 19)Klass is professor of journalism and pediatrics at NYU. Her most recent book is Every Mother Is a Daughter, with Sheila Solomon Klass.
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.
From Bookmarks Magazine
Jerome Groopman, Harvard professor of medicine, AIDS and cancer researcher, and New Yorker staff writer in medicine and biology, isn't new to the popular medical-writing scene. Before How Doctors Think, he penned three other books—The Anatomy of Hope, Second Opinions, and The Measure of Our Days—that explore the role of art in the hard science of medicine. Here, Groopman's readable prose emphasizes the human element, the give-and-take so important to successful diagnosis and treatment. One critic, however, compares the book's medical pyrotechnics to an episode of the medical show House, while another takes issue with the author's stance against Big Pharma. For the most part, critics see Groopman's latest effort as a compelling meditation on the interactions between doctors and patients—an effort reminding us that mistakes and miscommunications can be minimized but not eliminated.
Copyright © 2004 Phillips & Nelson Media, Inc.
From Booklist
By far the largest number of examples New Yorker staff writer and Harvard physician Groopman adduces to show how doctors think shows them thinking well for the good of their patients. In the initial example, one doctor seen by a woman with a long-standing weight-loss condition concedes being stumped and sends her to a specialist who finds the cause of her woes and, most probably, saves her from an early death. Both physicians are praiseworthy, the second more than the first only because he believed a patient whom others had come to pooh-pooh as a complainer and then thought of examining for something that the others had missed. The lesson? A doctor has to think with the patient, not despite or against her or from an assumption of superior knowledge. Subsequent chapters show doctors thinking in resistance to economic pressure by hospitals and insurers, in thorough solidarity with parents about their children's care, against a host of professional assumptions and in resistance to pestering by drug companies--all to help patients achieve their own goals as far as possible. An epilogue suggests a few questions patients should ask to help their doctors think clearly and, as the last chapter's title puts it, "In Service of the Soul." A book to restore faith in an often-resented profession, well enough written to warrant its quarter-million-copy first printing. Ray Olson
Copyright © American Library Association. All rights reserved
Most helpful customer reviews
2 of 2 people found the following review helpful.
Great reminder for physicians on common cognitive errors and how ...
By katarinaism
Great reminder for physicians on common cognitive errors and how to avoid them as much as possible. The theme of trying to attach a diagnosis to a patient that doesn't quite fit, often based on their demographics or what is 'most likely' is reiterated throughout the book. Of course common conditions can present in uncommon ways, but the emphasis on trying to reach a diagnosis right away opens up the risk of missing something important - one example cited aortic dissection misdiagnosed as musculoskeletal pain and another a compression fracture that turned out to be cancer in a young boy. While these examples are extreme they are certainly not unheard of. Another was overreliance on clinical algorithms which resonated with me.
As a neurology resident we commonly evaluate patients with suspected stroke and grade the severity based on several exam findings which together make up the NIH stroke scale. This score helps determine whether to administer a clot busting drug called tpa, which can decrease the disability caused by a stroke but comes with a nontrivial risk of bleeding, both systemically and in the brain. While a high score indicates a severe stroke (or some other global process mimicking a stroke), a low score can be deceptive, as even a low score can indicate significant disability. For example, one patient working in a very cognitively demanding field had intact motor function and speech but was unable to accurately calculate even simple equations. His score was 1 (the highest score is 32). While some may argue that the patient had a low score, without treatment he would not have been able to continue his career- a large consequence for someone in their prime. The decision was made to give the patient the drug, and the next day his Mri indeed showed small strokes in a part of the brain important in solving calculations. He had no residual symptoms, and no untoward side effects from the drug. The idea of treating each patient as an individual is thus emphasized.
Another point made in the book was not to prematurely write a symptom off as being psychological. I once admitted a patient with acute onset of altered mentation and agitated behavior who had recently lost their family member. The family had reiterated that the loss was a month ago and that up until a few days prior to coming into the hospital the patient had been completely normal with the exception of some normal grief. She had gone to another hospital prior who felt that this may have been psychological, as the patient had imaging that turned out normal and labs which showed no drug ingestion. I admitted that while I had some ideas for what may be causing it, we would need further testing to confirm. An eeg showed a pattern consistent with encephalitis and the patient was found to have suspected autoimmune encephalitis, which presents with very bizarre neuropsychiatric symptoms (read the book Brain on Fire if interested). She responded beautifully to a course of treatment that dampened the immune system's abnormal response.
Of course there are the misses too- a time that I once thought a brain wave test on a child with autism and tics signified seizures, but in retrospect was artifact from repetitive hand movements the child was making.
Overall, I loved this book. While the information presented is going to be familiar to most physicians, it will make you think critically about your practice behaviors and how to improve upon them, as well as the limitations of medicine.
1 of 1 people found the following review helpful.
Compulsory Reading For Those Seeking To Understands The Mind Of Doctors
By ZyPhReX
There are doctors that follow the tune that the Medical Industrial Complex plays, and there are ones who buck the trend. Dr. Groopman is one of the latter, thankfully.
In How Doctors Think, The New Yorker staff writer and Harvard professor of medicine & researcher Dr. Groopman offers a distinctive look into the structure of Big Medica in search for what exactly is the type of mindset Doctors employ when practicing their jobs.
Groopman does a compelling job throughout the book in making sure he relates the plights plaguing medicine from both sides of the coin, from the patients perspective, as well as from the perspective of a physician. This aids in the book not being one sided. It helps greatly that he’s also a Doctor with experience in this very field.
From medical, money, marketing, uncertainty, dogma, to various other components of medicine, Groopman attempts to turn over as many stones as possible in his search for what issues are the ones plaguing Doctors the most.
A notable point in the book that hit close to home, which many people will relate to is the emotional tension that can arise at times between patients and their doctors. Essentially, whether patients and doctors like each other. Groopman relates what Social Psychologist, Judy Hall discovered regarding emotional tension:
“..that those feelings are hardly secret on either side of the table. In studies of primary care physicians and surgeons, patients knew remarkably accurately how the doctor actually felt about them. Much of this, of course, comes from nonverbal behavior: the physician’s facial expressions, how he is seated, whether his gestures are warm and welcoming or formal and remote. “The doctor is supposed to be emotionally neutral and evenhanded with everybody,” Hall said, “and we know that’s not true.”[1]
What’s worse, is that Hall’s research indicated:
“…that the sickest patients are the least liked by doctors, and that very sick people sense this disaffection. Overall, doctors tend to like healthier people more.”[2] So much for quality health care.
Along with the above example, the author additionally notes many other examples of issues that arise due to a crisis in communication which can arrive in myriad ways.
In fact, one of these issues that Groopman relates is that:
“…on average, physicians interrupt patients within eighteen seconds of when they begin telling their story.”[3]
Another salient aspect of Big Medica that the author sunk his teeth into was the psychological aspect of medicine. Predictably, far too often doctors/western medicine view the patients psychological components as being apart from the body, rather than taking a much-needed holistic approach.
Additionally, the institutional dogma that reigns down from the top is also touched upon in a few instances by the author. Open-mindedness is scoffed at, while conformity was expected.
Recounting an example of choosing between the availability of multiple medical options regarding a particular treatment, Groopman relates something noted by physician Jay Katz, who taught at Yale Law school at the time:
“In both [treatments]…we were educated for dogmatic certainty, for adopting one school of thought or the other, and for playing the game according to the venerable, but contradictory, rules that each institution sought to impose on staff, students and patients.”[4]
Another disturbing component that doctors acquiesce to that is covered by Groopman is how doctors far too often give into to corporate interests. This very issue has covered by other doctors such as Dr. Brogan, Dr. Breggin, Dr. Mercola and many others.
This book sheds much needed light into the inner workings of how doctors operate – how they think. While the author notes that a sizeable amount of the issues have a variety of roots at the outset, such as communication, what he conveys still leads to much concern within the Medical Industrial Complex.
In the end, individuals will need to become much more proactive/responsible in their health if they plan to breakaway from the conventional medical system that puts profits over people.
____________________________________________________________________________________
Sources & References:
[1] Dr. Jerome Groopman, M.D., How Doctors Think, pg. 19.
[2] Ibid., pg. 19
[3] Ibid., pg. 17
[4] Ibid., pg. 153
Kindest Regards,
Zy Marquiez
TheBreakAway.wordpress.com
2 of 2 people found the following review helpful.
Changed My Life
By guzzihap
I have gone my whole life being afraid to talk straight to Doctors, and therefore never had much of success
getting the care to go in the direction that I needed it to go. I spent YEARS in a medical plan that served up to
me a new Med School Graduate every year as my GP. Each year I asked for help with my headaches and was
told that I didn't have a problem. I'd been hosed down with Agent Orange in Viet Nam, and had daily headaches
forever.
So I read Dr. Groopman's book and it taught me (an Engineer) how Doctors THINK. Now if you feel that you
just KNOW that Doctors have swelled heads, you never met a Design Engineer! We are the most egotistical
folks on the planet! But the book gave me the inside scoop on what I had been missing my whole life...a clear
understanding of what the DOCTOR is going through while He/She is interviewing you regarding your medical
history and complaints. It opened my eyes to the foolish mistakes I had been making all those years (decades).
I went to the next Doctor. Her name tag was so new it was hand-written. She explained to me that I didn't have
any allergies (like every year's Doctor had told me) and that I should just take a Decongestant. I told her if she
didn't send me to the Alergist, I would quit the plan. I FINALLY went to see an Allergist. They found some trouble,
and treated it immediately. Without this book, I would still be waiting to meet this year's new MD, with a headache.
It may sound corny, but this is a BREAKTHROUGH BOOK! You NEED it if you aren't getting the kind of results
from the Medical Profession that you want to get. It helps you CONNECT with your Physician, not just to bully him.
You really, truly need to understand how He/She thinks, and this is your KEY. BUY IT! BUY IT NOW!!! Hap
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