Tag Archives: medical logic

Book Review: How Doctors Think

How Doctors Think by Jerome Groopman, M.D.
Medicine is “a mix of science and soul”

by M.C. Parker

Have you ever sat in a doctor’s waiting room anxiously worried that you either (a) have a terminal illness, or (b) are completely wasting your doctor’s time? (Hopefully, you’ve done your online research via the Mayo Clinic and WebMD and have a written list of questions for the good doc.)

In case you’re wondering “What does my doctor really think?,” Dr. Jerome Groopman fills in the other side of the equation: How doctors think, how they decide the next step, and the way a doctor’s subconscious biases – from what you look and smell like, to whether he or she likes you – can influence treatment.

A little background: Groopman 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, Massachusetts. He also has 150 scientific articles to his name, and holds a staff writer position at The New Yorker, and is an editorial contributor to the New Republic, Washington Post, and New York Times.

The book is a fascinating read for both the medical and lay community alike as Groopman compassionately probes into the psychology of doctors, hopefully helping them become more self-aware, while helping patients see their doctor in a new, more approachable light.

Mysteries of the medical mind revealed
According to the author, the average doctor interrupts their patient within 18 seconds, and many times their diagnosis is accurate, but sometimes it is not.

Each chapter is chock-full of real-life medical mysteries usually involving colossal misdiagnoses. The reader is fully engaged as details about the players – doctors, medical staff, patients, friends and family – and the plot – identifying and treating the illness or injury – are slowly revealed. Sometimes, it’s a major improvement in the quality of life, and sometimes, it’s life or death.

The key premise of the book is that doctors are human. They are fallible, they have their good days and bad, and it affects the way they think at any given time. You should be aware that your treatment will be influenced by whether the doctor is having a good or bad day, feeling happy or sad, tired or well-rested, and whether he or she likes you.

This may sound like common sense, but no one has really speculated on how a doctor’s personality affects their decision-making skills and how they deal with mistakes.

Some doctors could take a page from House M.D.
When the prescribed treatment fails, doctors generally do one of two things: the good ones go back to the drawing board and use their investigative skills to “think outside the box,” the not-so-good doctors tend to try to justify the diagnosis, creating a Procrustean solution by disregarding what doesn’t fit.

The first incredible case Dr. Groopman cites is that of a woman diagnosed with anorexia nervosa. For fifteen years she has been suffering from cramps, nausea and diarrhea, and continues to lose weight. By the time she goes to see her umpteenth specialist at the urging of her boyfriend, she has been labelled by the medical community as “non-compliant” and a “psychiatric case.”

The specialist asks her to tell her story from the beginning and encourages her to talk. The patient goes through her symptoms and is adamant that she ate everything she was told to eat, but still continued to lose weight. The specialist does some blood work and convinces her to undergo one more test. It turns out she has celiac disease – an allergy to gluten – once believed to be rare. Within months of the diagnosis she is finally putting on weight.

Some other things you should know about doctors:

Nobody likes a hypochondriac
Unsurprisingly, the patients doctors dislike the most are the anxious, neurotic types who worry about every little ache or pain. Trying to separate the wheat from the chaff, doctors are worried they might actually miss something important due to the overwhelming and distracting volume of complaints.

That being said, if you are a bit of a neurotic, be upfront about it with your doctor, and that will help them take you seriously if you are really worried about something.

No one likes to fail
Some doctors dislike failure, and unfortunately, if they feel you’re a terminal case, they may start to avoid you. If this happens to you, it would be a good time to seek another opinion.

No one wants to hurt a friend
If you have a close relationship with your doctor, they may be reluctant to schedule any painful or invasive tests. It’s up to you to let them know that you’re willing to undergo any tests, painful or otherwise, that would help them reach a diagnosis.

On the flip side, if your doctor doesn’t like you, dismisses your complaints or avoids you, this would be a good time to get another opinion.

U.S. healthcare has varying price tags
Groopman explains that since U.S. doctors are allowed to bill specific amounts for different types of surgeries and treatments, and may be influenced by swag from pharmaceutical companies (trips, conferences, etc.), this can consciously or subconsciously influence the direction a doctor decides to take in your treatment. In that vein, he warns that surgery should always be viewed as a last resort option, and cites his own surgery as an example of how you shouldn’t be in a rush for a quick fix.

Good questions to ask your doctor
If you’re experiencing serious symptoms, Groopman recommends you voice your worst fears and let the doctor know what is really frightening you.

The author also recommends some very specific questions that will help you help your doctor keep an open mind when investigating your complaint.

1. What else could it be?
2. Is there anything that doesn’t fit?
3. Is it possible I have more than one problem?

This book is a must-read for anyone with a life-threatening illness, so please feel free to pass along this review.

Books by Jerome Groopman, M.D.
The Measure of Our Days (1997)
Second Opinions (2000)
Anatomy of Hope (2004).
How Doctors Think (2007)
Your Medical Mind (2011), co-written with his wife Pamela Hartzband.