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How Doctors Think Hardcover – March 19, 2007
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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 booksThe Anatomy of Hope, Second Opinions, and The Measure of Our Daysthat 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 patientsan effort reminding us that mistakes and miscommunications can be minimized but not eliminated.
Copyright © 2004 Phillips & Nelson Media, Inc.
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This process is most valuable when you are very sick, when a patient needs a doctor who can see around corners, who has the vision to think five steps ahead of and is able to act on, instead of just reacting to, a rapidly changing situation.
And while the best practitioners of any discipline demonstrate that big picture sensibility, they temper their confidence with a deep respect for the unexpected or unknown. In effect, they anticipate being wrong or dumb or both. This is confidence infused with humility.
Humility, which I thought was absent from Groopman's book "The Anatomy of Hope: How People Prevail in the Face of Illness," is on vibrant display in his latest work. Something changed in Groopman's perspective between "Anatomy," published in 2003, and "How Doctors Think," published in 2007. The voice in Anatomy was paternalistic and somewhat smug that given enough science, doctors would eventually be able to raise the dead.
A more humble and candid, but excited and empowered tone is present in this work. Groopman writes like a man on fire who has discovered the path to enlightenment through admitting failure and uncertainty. It's a fast-paced and dynamic story.
Groopman says, "arrogance is a product of narrow vision and ignorance." Does he speak from experience? Perhaps he'll tell all in his next book. An outstanding resource for both patients and doctors.
Anyone considering a career in medicine should read this, but anyone who may ever, possibly become sick or see a doctor (meaning, everyone) should be aware that doctors can get on a wrong track or make assumptions or mistakes, and a person needs to be their own advocate and press for different approaches if the existing one isn't working. Can't expect miracles nor flawless, error-free care, but never hurts to question and re-assess things.
This author has written many books, all seem highly rated, but this is the only one from him that I've read so far. We have some doctors in our family and more coming, and we are all patients at one point or another, so it's an interesting and helpful book. It is a bit longish and at times a bit redundant, but not oppressively so. The subject is compelling and the author is highly knowledgeable in the profession.
I work in health care, in finance and have since 1988. This book a look at how physicians are trained, and how their training as well as their experience impacts the way physicians think, and diagnose their patients. Dr. Groopman put it this way. "This book is about what goes on in a doctor's mind as he or she treats a patient."(p3) The book is about cognitive errors physicians make and how patients can contribute to their physician's successful diagnosis and treatment. The author, a practicing oncologist posits comments on how healthcare economics undermines the chances of avoiding the mental errors that lead to incorrect diagnoses. (People like me get labeled "bean counter" with great aplomb. [pp90, 100, 127])
Jerome Groopman chronicles how patients access physicians, through hospital emergency rooms, primary care doctors, surgical specialists, and radiologists. During this discourse, he labels a number of thinking models, common to physicians and the intellectual errors that are linked to those models. Additionally, he spends a significant amount of time discussing how the modern practice of medicine exacerbates the conditions that may lead to misdiagnosis.
Dr. Groopman repeatedly dicusses a cognitive model for diagnosing patients followed by a criticism of the model's weakness, demonstrated by a misdiagnosed patient. He criticizes the evolution of quality programs and "evidence-based medicine" programs in hospitals across the country. "Physicians should caution themselves to be not so ready to match a patient's symptoms and clinical findings against their mental templates or clinical prototypes. This is not easy. In medical school, and later during residency training, the emphasis is on learning the typical picture of a certain disorder...'Common things are common'...'When you hear hoof beats, think about horses, not zebras...Powerful forces in modern medicine discourage hunting for [zebras]." (pp126, 127)
He criticizes of the economic organization of medicine, today.
"...deliberate analysis...requires time, perhaps the rarest commodity in a healthcare system that clocks appointments in minutes...Today, medicine is not separate from money. How much does intense marketing by pharmaceutical companies actually influence either conscious or subliminal decision-making? Very few doctors, I believe, prostitute themselves for profit, but all of us are susceptible to the subtle and not so subtle efforts of the pharmaceutical industry to sculpt our thinking." (p178)
This book is not a "page-turner." Dr. Groopman's examples are interesting, though they make me as a non-clinician frustrated. His attacks on evidence-based medicine can feel like an attack on those that want to reduce medical uncertainty, and their motives. His description and sometimes praise for a model of diagnosis, usually to be followed by the parallel pitfalls of that model can leave me feeling in despair. The first time I tried to read it, it was over a month long period and I had only gotten half way through the book. It just didn't compel me. When I began rereading it, I pushed through and got it completed in about one and a half weeks, skipping several days.
Dr. Groopman talks about how doctors know what they know, and discusses the general environmental characteristics that lead to intellectual errors in medicine. I have seen similar forces influencing the business and industry of health care. In seminars and webinars, I see ideology, groupthink, magical thinking, fashionable nomenclature and platitudes being used as substitutes for real strategic thought and planning, then becoming conventional wisdom. Many times the tools we all learned in business school are being ignored rather than to challenge the trendy idea being proffered. It is as if business strategy has more in common with finger painting than business science.
This book was worth reading! This book reminds me that these problems, paradigm lock, unwillingness to challenge authority, blindness to extraneous data are pervasive. I need to listen more, respectfully question, learn from my own errors in thinking. I have drawn value from How Doctors Think. I just had to work to get at that value.