How Doctors Think

In a groundbreaking new book, HOW DOCTORS THINK (Houghton Mifflin; March 19, 2007; Hardcover; $26.00), New Yorker writer Jerome Groopman, M.D., explores a topic that is the most overlooked—and most important—in medicine today. Through compelling statistics, interviews with some of the country’s most renowned physicians, and his personal experience as both a doctor and a patient, Groopman examines for the first time not only how doctors can think better, but how patients can improve their health by knowing how doctors think. The majority of mistakes made each year in medical diagnoses and treatment are made because of errors in doctors’ diagnostic thinking, Groopman writes, not because of technical mistakes like reading a chart incorrectly. This leads to any number of complications with patients, including, in some extreme instances, death. And the vast majority of patients have no idea how to make their doctors to address their concerns appropriately, or even how to tell when mistakes are being made. “We’ve all wondered why a doctor asked certain questions, or detoured into unexpected areas when gathering information about us,” Groopman writes. “We have all asked ourselves exactly what brought him to propose a certain diagnosis and a particular treatment, and reject the alternatives. Although we may listen intently to what a doctor says and try to read his facial expressions, often we are left perplexed about what is really going on in his head. This ignorance inhibits us from successfully communicating with the doctor, from telling him all that he needs to hear to come to the correct diagnosis and advise on the best therapy.” In the book, Groopman tells countless stories about men, women, and children whose diagnoses doctors got wrong—sometimes more than once. A woman with celiac disease was diagnosed as anorexic for years, losing weight without relief until she was a ghost of her former self. A baby girl from Vietnam was kept in the ICU until her adoptive mother drew the doctor’s attention to a possible cause for her condition—and it was the correct one. Groopman himself, not wishing to cause discomfort to a patient he liked, didn’t check the man’s back in the hospital, encouraging the growth of a painful abscess. He also tells the story of his own quest for a doctor who could diagnose the mysterious, debilitating pain occurring in his right wrist—something that took a humbling three years to do. In many cases, the cause for the misdiagnosis is that the doctor locks into his or her first impressions of the case and doesn’t consider other possibilities, Groopman writes. But many more components can get in the way. A doctor might like a patient and not want to order extra tests to inconvenience them. If he or she feels a patient is annoying and needy, they may spend as little time as possible talking with them. If a doctor is running behind on his or her schedule for the day in an effort to be efficient, a patient might sense this and decide not to ask about something that has been bothering them. And if someone comes into a busy emergency room needing immediate care, the information needed to make an accurate diagnosis might be too late in coming. There are several things that patients can do to arm themselves against a doctor’s cognitive slips. “The first detour away from a correct diagnosis is often caused by miscommunication,” Groopman writes. “So, a thinking doctor returns to language. ‘Tell me the story again as if I’d never heard it—what you felt, how it happened.’ If he doesn’t ask you to do this, then you can offer to retell your story. Telling the story afresh can help you recall a vital bit of information that you forgot. Telling that story again may help the physician register some clue that was, in fact, said the first time but overlooked or thought unimportant.” Groopman also recommends: ·Patients should never feel inhibited with their doctor—if something is bothering them or causing them discomfort, their doctor needs to know about it; ·People should ask their doctor tough follow-up questions to make sure they understand what will happen if they accept a particular medication or procedure; ·Individuals should feel free to take their time with their doctor. Even if the physician seems rushed, they have a responsibility to listen to their patients’ concerns. Through it all, patients must be an active partner with their doctors to make sure their health is provided for. HOW DOCTORS THINK is a telling look inside health care today, and an invaluable book for doctors and patients alike. HOW DOCTORS THINK By Jerome Groopman, MD Houghton Mifflin On sale: March 19, 2007 Hardcover / 320 pages / $26.00 ISBN-10: 0618610030 ISBN-13: 978-0618610037