Second Opinions: Eight Clinical Dramas of Decision Making on the Front Lines of Medicine [Paperback]

Jerome Groopman MD (Author)

Book Description

Publication Date: February 27, 2001

A unique insider's view of today's complex and often contentious world of medicine

Anxious about the prognosis, lost in a blur of technical jargon, and fatigued from worry or pain, people who are ill are easily overwhelmed by treatment choices. Told through eight gripping clinical dramas, Second Opinions reveals the forces at play in making critical medical decisions. Dr. Jerome Groopman illuminates the world of medicine where knowledge is imperfect, no therapy is without risks, and no outcome is fully predictable. He portrays moments of astute diagnosis and misguided perception, of lifesaving triumphs and shattering failures.

These real-life lessons prepare us to navigate the uncertain terrain of illness, and enable us to balance intuition and information, and thereby make the best possible decisions about our health and future.

Editorial Reviews

Amazon.com Review

Respected AIDS and cancer specialist Jerome Groopman, M.D., discussed the convergence of illness and spirituality in his first book, The Measure of Our Days. In Second Opinions: Stories of Intuition and Choice in the Changing World of Medicine, he shifts his focus to the ways intuition informs his medical decisions and enhances the quality of his patient relationships (even giving him an edge when examining a patient on referral). In eight chapters that vividly recount cases whose outcomes hinge as much on the doctor's gut feeling and empathy as on his expertise, Groopman eschews the impersonal and know-it-all role of the doctor, describing instead dire cases in which careful consideration of both the emotional and medical issues positively impacted his approach to treatment.

"A clinical compass is built not only from the doctor's medical knowledge but also from joining his intuition with that of his patient," Groopman writes. "This melding of minds occurs when the physician probes not only his patient's body but also his spirit." This uniquely integrated compass is the guide that determines the safest, least traumatic treatment for people who are in advanced stages of illness or whose diagnoses are clinical conundrums. Of the eight stories here, there's Isabella, who was diagnosed with asthma but actually has acute leukemia; Peter, whose sickness is an enigma although he's clearly dying of a vicious lung-tissue disorder; and Alex, who will die from bone marrow failure unless its exact cause is identified. Groopman's narrative nimbly relates all the details of his patients' battles as well as the professional and emotional steps he takes when facing a medical challenge. In most cases, he has been sought out to provide a second opinion of the patient's diagnosis and proposed treatment. More often than not, the original diagnosis was inaccurate and Groopman's meticulous and insightful examinations yield findings that mean the difference between life and death.

Second Opinions is a thoughtful, riveting book and a compelling tribute to the efficacy of medical care when handled responsibly and with empathy. It is also a cautionary collection of stories that reveal oversights inevitable in the health-care industry's rush to maximize efficiency, and as such it teaches an important lesson about the patient's role in ensuring a high quality of care. While Groopman runs the risk of seeming self-congratulatory, he proves himself a trustworthy advocate of patient empowerment and his sincere, articulate portrayal of intuition's subtle force will be inspirational for anyone confronting illness. --Rebecca Wright --This text refers to an out of print or unavailable edition of this title.

From Publishers Weekly

As he so ably demonstrated in The Measure of Our Days, Groopman, a clinician and researcher at the Harvard Medical School, writes expressively and compassionately about illness. In the eight case histories presented here, he beautifully illustrates his strong belief that "a clinical compass is built not only from the doctor's medical knowledge, but also from joining his intuition with that of his patient." A well-respected hematologist told Alex Orkin he had six months to live unless he underwent a bone marrow transplant. In the absence of an appropriate donor, a very dangerous unmatched transplant was scheduled. Orkin then consulted with Groopman, who, after repeating many tests and getting to know his patient, concluded that the diagnosis was unclear and the proposed transplant too risky. Groopman intuitively decided to rely on a dictum learned in medical school: in some cases it is preferable to do nothing. Despite one scary bout of pneumonia, Orkin's marrow production increased and he recovered. Some of the other histories don't end so happily, however. One case involved a misdiagnosis of asthma by a managed care physician; by the time Groopman became involved and correctly diagnosed acute leukemia, it was too late. The author is convinced that the money-saving practices of HMOs are causing a loss of quality medical care. He also movingly describes his own experience, in which his infant son nearly died because the pediatrician, a poor diagnostician, apparently overlooked a serious condition. Fortunately, the medical expertise of Groopman and his wife (also a physician) saved their son's life. This is an excellent book by a thoughtful physician. First serial to the New Yorker; second serial to Good Housekeeping. (Mar.)
Copyright 2000 Reed Business Information, Inc. --This text refers to an out of print or unavailable edition of this title.

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Product Details

• Reading level: Ages 18 and up
  
• Paperback: 256 pages
• Publisher: Penguin (Non-Classics) (February 27, 2001)
• Language: English
• ISBN-10: 0140298622
• ISBN-13: 978-0140298628
• Product Dimensions: 7.8 x 5.1 x 0.5 inches
• Shipping Weight: 6.4 ounces (View shipping rates and policies)
• Average Customer Review: 3.7 out of 5 stars  See all reviews (19 customer reviews)
• Amazon Best Sellers Rank: #824,643 in Books (See Top 100 in Books)

More 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. He has published more than 150 scientific articles. He is also a staff writer at The New Yorker and has written editorials on policy issues for the New Republic, the Washington Post, and the New York Times. His previous books include the New York Times bestseller The Anatomy of Hope, Second Opinions, and The Measure of Our Days. Groopman lives in Brookline, Massachusetts.

Customer Reviews

Most Helpful Customer Reviews

47 of 56 people found the following review helpful:

5.0 out of 5 stars A thought provoking must read work, March 13, 2000

By 

Harriet Klausner - See all my reviews
(#1 Hall OF FAME REVIEWER)    (REAL NAME)   

This review is from: Second Opinions (Hardcover)

Dr. Jerome Groopman relates eight true-life short stories centering on medical care during a health crisis. He looks closely at the decision point when a patient encouraged by his doctor chooses the path he or she wants to take. Often ignored is the possibility of doing nothing, a legitimate decision in which the status quo might prove statistically to be the better response than the medical solution. Dr. Groopman also examines the aftermath of an improper diagnosis.

The stories are well written, interesting, and though not all end happily, they do provide the reader with enough information to enable the audience to take control of the medical decision process. Any "solution including the status quo involves risk, but Dr. Groopman explains what factors the patient and his or her family should consider in deciding what they think is the right course for them. SECOND OPINIONS is a must read work consisting of simple, heart wrenching true-life stories that offer much insight into the emotional process used in making medical decisions. With this primer and his previous book (see THE MEASURE OF OUR DAYS), Dr. Groopman proves he is one of the leading writer on modern day health care.

Harriet Klausner

23 of 26 people found the following review helpful:

4.0 out of 5 stars Engrossing medical stories, July 23, 2001

By 

Dennis Littrell (SoCal) - See all my reviews
(TOP 500 REVIEWER)    (VINE VOICE)    (COMMUNITY FORUM 04)    (HALL OF FAME REVIEWER)    (REAL NAME)   

This review is from: Second Opinions (Hardcover)

Yes, Dr. Groopman does have a rather elevated opinion of himself, and yes, this book serves admirably as self-promotion, but, so what? Dr. Groopman's inability to assume a socially correct humility may be annoying and distracting to some, but I found it amusing and almost endearing. He wants so much to please and be that delight of mothers everywhere, "my son, the doctor," that it is impossible for him to show himself in an unflattering light. Even when he volunteers his mistakes, one has the sense that he is a larger person for having done so!

Well, I can think of worse styles, and anyway, what is important about this book is not the author's self-perception, but the light he sheds on the practice of medicine for the reader, and that light is considerable. He has a fine gift for telling a story and he writes in a clear and vivid manner that is easy to read, and we are thoroughly engrossed . Furthermore, the moral of most of the very interesting stories he presents here from his practice, is that the physician's first responsibility is to the patient, not to his ego, not to his career, not to the HMOs, and not even to his fellow physicians.

I was particularly impressed with Dr. Groopman's ability to criticize those physicians who let their egos and their pride come before their patients. He wasn't afraid to show how doctors who do not put the welfare of their patients first can cause pain and suffering and even death. Most doctors would never come close to being as critical of their peers as Groopman is here. I don't know whether he has an inordinate amount of courage, or a particularly thick skin, but I do know that many doctors will not be pleased with what he has revealed in these pages about the competence of some physicians, and he will pay a price for that.

Also impressive was Dr. Groopman's unflinching willingness to share with the reader not just his clinical experience, but his personal experience as well. In the first chapter, "Our Firstborn Son," he and his wife, who is also a doctor, become worried parents who take their sick son to the emergency room of a hospital, feeling as vulnerable and helpless as any other parents would, especially when they become concerned that the doctor on call is misdiagnosing their son's illness. In a later chapter he shares the story of his Grandfather Max who suffered from Alzheimer's disease in a way that made him uncontrollably violent. Most significant, though, is the story he tells about himself in the prologue. It is disarming in the sense that he too is guilty of pride and suffers most painfully for it. Once a marathon runner, he ends up crippled for a year, and to this day has a chronic debility that limits his mobility, all because he thought he knew better than the doctors who were treating him. It was a great and painful lesson for a young physician, the kind of lesson that molds us to better appreciate our limits and to empathize with the suffering of others, the kind of lesson that shapes a great physician.

So, I don't believe Dr. Groopman is ensconced in any ivory tower. He is a physician that is intimately involved in the welfare of his patients (and in his research), a man who understands the suffering patients go through first hand, and is sympathetic and, most important, knowledgeable and skillful. He is also a very good writer. I would be delighted to be so lucky as to have Dr. Groopman as my personal physician.

17 of 21 people found the following review helpful:

3.0 out of 5 stars Some Interesting Views Even if from a Bit of an Ego Trip, April 17, 2000

By A Customer

This review is from: Second Opinions (Hardcover)

The book is an interesting, quick read, although marred by Dr. Groopman's being pretty stuck on himself. Still, Dr. Groopman underscores some problems in health care delivery that demand immediate correction. The best of the book already appeared in the New Yorker; if you read the two chapters published there, the rest of the book adds very little.