How Doctors Think

This book was interesting for me, given that my dad's a hematologist, which is the specialty of the author of this book. I've learned throughout my life in grad school and dealing with doctors occasionally that everybody -- even so called "smart" people -- aren't always on the ball, and sometimes you have to be skeptical of an expert's opinion. This book pretty much lays that out.

HOWEVER, why is it that in the year 2007, the author can't seem to use a single female pronoun in the entire book when referring to a generic person? (Actually he does, once, at the end, to refer to a generic patient.) And then he has the gall to mention that female doctors don't get taken seriously. Well, if everybody writes books and articles referring to show more doctors as "he," it's no wonder that stereotype continues to this day. show less

An excellent review of how doctors come to make diagnoses, and what errors are most likely with the different methods. It is written for the layman, with relatively little jargon, and that jargon is carefully explained whenever it appears. An engineer can think about a problem logically, then test the results to destruction. A doctor needs to be aware that there are variables that cannot be controlled for, and he or she knows there are some experiments that cannot be made. So how a skilled diagnostician uses the limited data available - how he asks the questions, how he interprets the answers and the test results, what's "going around", how he handles uncertainty, and how he himself was trained, all inform the diagnosis he arrives at. show more This book is useful for doctors, to help understand how diagnoses are made, and how they can be made better. It is also useful for patients - if a treatment is not working, how can you help your doctor look at it another way. It also shows that while there is much science in medicine, there is also much that is not known. This book also explains quite clearly the Baysian Analysis approach to medicine (also called "evidence based"): where it shines and why it sometimes leads away from the truth for a particular patient. There is some discussion of how our insurance system affects our care -- where "quality measures" may indicate that the process is working well, but an individual patient may benefit from a different process. This is a clearly written, easily read book, and provides valuable insights for patients (which is, nearly all of us) as well as physicians. show less

It makes perfect sense when you reflect on it, but Groopman's description of the Bayesian indoctrination of doctor training provides a lot of insight into the common conflicts or deficits of medical interaction. The takeaways aren't simplistic so much as simply reinforcing that patients and peers should remember that doctors are human. Cognitive errors are common, no matter how elite and trained a professional is. Patient advocacy and a deeper engagement with a specialist's rationale is not easy to appreciate or apply until you realize just how often common medical conventions prevent them from even being considered.

Or, how new residents, internists, radiologists, surgeons, general practitioners, pediatricians, etc, make decisions including wrong decisions, in life and death situations. The early anecdote of the author being alone in a ward, with nothing but a stack of 3X5 cards, is chilling. It just shows how amazingly brave one has to be, to simply be a doctor.

The book goes on and on with complicated case descriptions that show potential decision errors in bias, influence of training, and even drug and medical product marketing.

I'm sure concepts described here could be carried over to Chemical Safety Board and FAA investigators, auto mechanics, veterinarians and many different trades. Stay with this one. It is long and technical, but you will show more learn a great deal of interesting medicine along the way. show less

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 show more 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.

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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 show less

This book is written to try to explain how doctor's think for anyone who's ever been a patient. Groopman has thoroughly researched this topic, both by interviewing doctors and gathering as much relevant information on medical decision-making as he could. In short, he explains why doctor's make mistakes in diagnosis. It all comes down to being human.

In each chapter, Groopman describes an interesting case study in order to show a cognitive 'flaw' in diagnosis. I'll just list a few:

Doctors are taught to use Occam's razor, to find one answer whenever possible instead of two. But of course, sometimes a person really does have two conditions, lactose intolerance and irritable bowel syndrome, for instance, or Lyme disease complicating an old show more injury.

Doctors are taught to use statistics. If symptoms x, y, and z mean A 90% of the time, then they are taught to suspect A. In reality of course, 10% of their patients will have B, but it's hard to break out of the odds and insurance companies of course insist upon probabilistic methods.

Human beings are influenced by recent experience. If a doctor made a mistake in diagnosis once, he is much more likely to look for that combination of symptoms again, possibly over-compensating.

The power of positivity: if a test show something wrong (a mass on the MRI/ bad blood chemistry), a doctor may attribute the current symptoms to that condition, even though they could be unrelated.

No single doctor can know all existing medical knowledge. Thus, specialists view problems in terms of their specialty and generalists have less depth in any one field. Especially for obscure conditions, this can make diagnosis difficult.

Groopman goes on at great length, but the list is actually quite an interesting attempt to explain how people, not just doctors, deduce things. Many of the flaws Groopman points out are unavoidable. If there is a flaw in the book itself, it is that he is too little an apologist. That is, he seems to think doctors can learn to avoid these mistakes (true to some extent) and that if you just keep looking long enough you'll find a doctor who can give you the right diagnosis to your problem. Doesn't anyone remember anymore that we don't actually have an explanation for everything? If we did, we could pack up and go home. They could just reissue the same edition of all medical texts year after year. No, we are still learning, so even the best doctor, even the best collection of doctors, may not have an answer.

What Groopman does well is give the patient power to be part of the decision, to ask his doctor to think outside the box, to know no one is infallible, to participate. All in all, this was an interesting book, well-researched and with some very good observations. show less

Like being inside Dr. House's head - well, if he also had a bedside manner. Oh, and admitted mistakes. Also, blessed with humility. If there's a double, overarching takeaway from this book, it's to a) speak your mind and voice your concerns, b) get a second opinion.