Saturday, March 24, 2007

How Doctors Think

How Doctors Think
By Jerome Groopman

Jerome Groopman is well known 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.Yet, this book is something different: a sustained, incisive and sometimes agonized inquiry into the processes by which medical minds, 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: "most errors are mistakes in thinking.
This is an honest, touching, and insightful look at the paradigms with which doctors make diagnoses and decisions, with examples of when this really works and when it fails and why.
Although it's actually a review text book geared toward medical students and nurses, without the 'human' side and beautiful prose of Groopman's book, it's so simply written that anyone can understand it (perhaps with a little help from Google once in awhile for a term). So if after reading about doctors' thinking on the more philosophical level in "How Doctors Think," you're interested in understanding the type of diagnostic reasoning and treatment planning that occurs on the more scientific/physiological level , in other words, the essence of what you learn in med school,you would really enjoy Clinical Pathophysiology Made Ridiculously Simple.
It also has a chapter that walks the reader through different case scenarios and how a doctor should reason through them to make a diagnosis case you ever wondered why the doctor presses here, listens there, orders such and such test, etc. Often when confronted with disease, one of the most important parts of the healing process is understanding it; this book allows you to do so from a reliable source, without having to filter through all of the information (and mis-information) on the internet.
Understanding how your body works and what happens when it does not will help you to better deal with illness and understand what doctors are telling you....or if you're an 'amateur' scientist, you'll just enjoy this easy-to-understand book on the physiology of disease and diagnostic reasoning. Like I said, it's a text book, not a general audience book like "How doctors think," but if you're looking for an interesting companion read to Groopman's important and insightful book, you might find it interesting to read Clinical Pathophysiology Made Ridiculously Simple.
This alarming statistic introduces Dr. Jerome Groopman's compelling analysis of how doctors think and what this means for patients seeking diagnoses. Groopman is curious to discover how one doctor misses a diagnosis which another doctor gets. Interviewing specialists in different fields, he analyzes the ways they approach patients, how they gather information, how much they may credit or discredit the previous medical histories and diagnoses of these patients, how they deal with symptoms which may not fit a particular diagnosis, and how they arrive at a final diagnosis.
Throughout, he considers the doctors' time constraints, the pressures on them to see a certain number of patients each day, the limitations on tests which are imposed by insurance companies or by hospitals themselves, and the many options for treating a single disease. He is sympathetic, both toward the patient and the physician, and, because he himself has had medical problems, he provides insights from his own experience to show how physicians (and patients) think. Case histories abound, beginning with the 82-pound woman, whose celiac disease was not diagnosed for fifteen years. Here Groopman analyzes the uses and misuses of clinical decision trees and algorithms used by many doctors and hospitals to assess probabilities and make decision-making more efficient. Sometimes, however, it is necessary for a doctor to depart from the algorithm and obey intuition. Recognizing when the physician is "winging it" depending too much on intuition and too little on evidence is a challenge for both patients and other physicians.
Ultimately, Groopman focuses on language as the key to diagnosis, showing that when patients and physicians can communicate and truly share information, they have a better chance to come to correct diagnoses and appropriate treatments. The success of Groopman's book attests to the need for discussion of these issues, but I am not sure Groopman realizes the difficulty patients have in finding ideal doctors whose personalities, thinking, and communication styles are compatible with their own. Most of us are referred to specialists by our primary care physicians ,some of whom we see only once a year and do not know well, and it is not possible to interview several specialists to find the one most compatible. We accept the appointment our primary care physician has set up for us, often with the specialist who has the earliest available appointment. Patients with urgent problems may have fewer choices than Groopman seems to think they have. Though we all search for the ideal, ultimately we must hope that our own diagnoses are not among the "problem fifteen percent."
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 this book an immediacy and an eloquence that will resonate with anyone interested in medicine or science.

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