Customer Reviews

Second Opinions

5 star:		(8)
4 star:		(5)
3 star:		(1)
2 star:		(3)
1 star:		(2)

 

 

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

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.

I've enjoyed Dr. Groopman's essays in the New Yorker and so was happy to learn about this book, which I found to be a highly compelling and instructive read. Groopman is no Tolstoy, but he writes with precision, clarity, compassion and great understanding about people struggling for their lives, usually against cancer, and the peculiarly intimate role a good doctor plays in that struggle.

Of course, one of the unifying threads of the book is also the potentially life-threatening role a bad doctor can play in that struggle -- thus the need for second opinions and the difficulty many patients have in demanding them. Groopman is usually the good doctor here, saving his patients from the misguided diagnoses of others. But he doesn't entirely spare himself his sins. He forcefully highlights the way a doctor's inexperience, fatigue, ego, or momentary inattentiveness can have potentially fatal consequences. His deep experience as both clinician and researcher give the stories real authority.

What really struck me, though, was how such a collection of case studies is like a fictional short story collection only more satisfying for the fact that these are classic beginning, middle and end stories that are in fact true. As important, Groopman begins with one of his own family's stories, which effectively draws you in to his own life. That's important because this is ultimately a portrait of the kind of super smart and caring physician we'd all like to have when facing a crisis.

Gideon's Crossing owes a lot to this book, having already built a couple of episodes around case studies found here. The ultimate compliment, I guess, is that Groopman has created a vision powerful enough to deserve Andre Braugher.

I'm somewhat amazed by the comments of the other reader reviewers (though less so by the self-identified physician, who seems to me to be suffering from sour grapes more than anything else in referring to Groopman's "ivory tower"). I found this books to be gripping and thought-provoking--as moving in its way as Tolstoy's "Death of Ivan Ilyich" or Chekhov's "Ward Six," two other classics of doctor-patient relationships). Groopman writes with passion, precision, and elegance. Only incidental to me was his powerful rhetorical point--urging all of us to be as proactive as he in taking active, questioning roles in our own health. Perhaps the physician-reviewer is put off by the fact that Groopman does not seem to subscribe to the "omerta" of too many in the medical profession, but places the patient first, even though he is a committed researcher. I also recommend Groopman's earlier book, "The Measure of Our Days" and the edited volume, "AIDS Doctors: An Oral History," which gives voice to Groopman and many other brave warriors of the hospitals.

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.

This thought provoking and often disturbing book should come with a warning. It will make you question the judgment of your doctor if you or someone you know is ever faced with diagnosis and treatment of a life-threatening illness. Medical science and technology continue to make great strides forward, but following each of the case histories related by Dr. Groopman in this book, you realize how tenuous is the judgment of individual doctors who must advise patients and lead them to decisions affecting their health.

Reason, in the delivery of health care, is balanced against intuition, and intuition can take many forms, including doubt, egoism, professional jealousy, impatience, resistance, and anger, all of which appear at one time or another in the stories Groopman tells. Or, as one of his patients says, intuition is reason operating below the level of awareness. Making life-saving decisions is, we realize, a matter of expert guess work, and if there's a lesson here it's that the best guess work comes from intimate knowledge of the patient, which the cost-saving constraints of managed health care often prohibit.

I recommend this book for anyone wondering how much trust to put in the medical profession. A well trained and experienced doctor can still make the difference between life and death, but Groopman shows how patients need to play an active role in decisions about their own health, and that often involves seeking a second opinion and making a choice between incompatible courses of action.

His book follows eight ideas.

---Panic drowns both reason and intuition.
---If you can't explain it well, you don't understand it.
---ET or Ej. Error in technique or error in judgment. (arrogance)
---Go effortlessly between macro & micro view.
---Managed Anything-functions poorly on the unusual and individuals
---Don't prolong the diagnostic Dance.
---If you cure, then $ flow stops. (and that's a good thing)
---Never interfere with the Blood Brain Barrier!

I enjoyed his engaging writing and the non-intimidating level of medical detail. Overall, I felt Jerome had good examples to showcase
- the value of second opinions
- the value of having someone else arrest a sense of panic even when the situation was close to emergency
- the value of putting down one's ego in the face of doubt/uncertainty
- the challenges of doing medicine with limited knowledge and limited time
- the tradeoffs of not-causing-harm and taking-risk

The only con of the book I felt was that the Doctor did not showcase any situations where he goofed because of bad judgment; He was either portrayed as a champion because of superior knowledge or judgment, and when he was not able to save a life, it was because of a mystery which the doctor could not be blamed for. I suspect he could not talk about his more controversial cases due to vulnerabilities of lawsuits.

I ran across this book when I was in the mood to review literature related to how medical decisions are made and what physicians can do to improve communication skills to their patients. The author, Dr. Jerome Groopman is a physician who has been instrumental in changing the course of treatment in other patients, himself, and his children based on his combination of intuition, knowledge, and listening skills.

As a physician in medical "practice" I have always been of the opinion that it is important to connect with patients and to condense and translate the science of medicine into practical information that patients can use to make informed decisions. The physician patient relationship has always been fraught with challenges to communication and the current proliferation of information (both good and bad) makes the physicians job that much more difficult.

In a setting with so much risk and potential danger, excellent communication is essential; however, the physician should also avoid the temptation of falling into cookie cutter solutions or oversimplification.


I am not sure that I agree with Dr. Groopman's approach in all cases, but this book is very readable and thought provoking.

It is a particularly important source for physicians who wish to explore ways to provide exceptional service to patients in today's complicated medical landscape.

Highly recommended.

This is an outstanding book. From Hipocrates to Avicena, from Maimonides to William Osler and so on to our days, leading physicians have wrote the same message about the core of medical practice and profession, using different words. This book is an actualized version of the same message. Physicians have the responsability to know and keep updated with the huge amount of scientific facts they should manage to treat patients properly. They should become real experts so on providing patients with the best possible quality of medical care. Nevertheless, a physician should never forget this is only a part of what medical practice should be. They treat individual persons, each of them with their own feelings, fears and expectations, with realities, relatives and responsabilities, with opinions, intuitons and hopes. A physician should give patients time, effort and dedication and should be there, even when the time has come to sweat, cry and die. Dr. Groopman give us a remembrance of this concept using eight vivid examples of his medical and personal life. In Second Opinions, Dr. Groopman give us also a voice of alert on how insurance companies and HMO's are dramatically changing the practice of medicine, and their influence on the deshumanization of the doctor-patient relationship. He writes about the need of doctors to remain being healers, taking care both for bodies and souls and he writes about how healers will thanks G-d for allowing them to do what they do every day. This is what this book is all about. Dr. Groopman has outstandingly succeded to show us what the practice of the art and science of medicine should be.