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How Doctors Think
PDF Download How Doctors Think
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Review
Starred Review. SignatureReviewed by Perri Klass I 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. (Publishers Weekly )By turns inspiring and dismaying, [the book] explains how even the best doctor can draw the wrong conclusion, and why that same doctor might also come up with a brilliant diagnosis that has eluded his peers. Uncertainty hovers over the practice of medicine, which Dr. Groopman, a clear writer and a humane thinker, presents as an art as well as a science, despite the spectacular advances in medical technology. (The New York Times - William Grimes )
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About the Author
Jerome Groopman, M.D., holds the Dina and Raphael Recanati Chair of Medicine at Harvard Medical School and is chief of experimental medicine at Beth Israel Deaconess Medical Center in Boston. A staff writer for The New Yorker, he is the author of How Doctors Think, The Anatomy of Hope, Second Opinions, The Measure of Our Days, and other books.
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Product details
Paperback: 336 pages
Publisher: Mariner Books; Reprint edition (March 12, 2008)
Language: English
ISBN-10: 0547053649
ASIN: B0029LHWKY
Product Dimensions:
5.5 x 0.8 x 8.2 inches
Shipping Weight: 12 ounces (View shipping rates and policies)
Average Customer Review:
4.6 out of 5 stars
405 customer reviews
Amazon Best Sellers Rank:
#333,332 in Books (See Top 100 in Books)
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.
After suffering heart failure and a triple bypass at the age of 54, the recovery has been difficult. That was 5 years ago. What has been more difficult is communicating with my physicians. 10 months ago, I took my health into my own hands and changed my diet and supplementation. It has been an about face in my health. Blood and cardiac tests do not lie. I have kept what I am doing from my doctors in order not to second guess all my efforts in such a short time. This book helped me immensely in my last primary and cardiologist appointments in finally coming off most of my meds and replacing them with supplementation. Before reading this book I was met with raised eyebrows, but I am now able to tactfully communicate to my doctors that I am more than a "patient medical googler" and someone that has finally became responsible for my own health.
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.â€[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.â€[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.â€[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.â€[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. 153Kindest Regards,Zy MarquiezTheBreakAway.wordpress.com
A colleague of mine gave me this book after I graduated vet school. It's an excellent look into the thought process doctors use when diagnosing and prescribing treatments, and highlights some of the common hangups they can experience that can lead to a misdiagnosis. I recommend this book to any doctor and any patient, it's well written and holds your interest. Indeed, I reread it every few years to remind myself not to fall into the common mind traps that lead to mistakes.
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