In How Doctors Think , Groopman analyzes how physicians come to make diagnostic and treatment decisions, and how this process can be improved upon. He approaches this in a case-based manner, by way of analyzing mistakes made in diagnosis and treatment. In each chapter, Groopman presents cases in which particular diagnoses were arrived at in error, often by separate, but not always independently thinking, physicians. He also presents cases in which difficult diagnoses were arrived at correctly, drawing attention to the important differences between the cognitive processes at play in each case and the resultant outcome. By doing this, Groopman highlights several types of common cognitive errors made by physicians. It is worth briefly reviewing them here.

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This elegant, tough-minded book recounts stories about how doctors and patients interact with one other. In the hands of Jerome Groopman, professor of medicine at Harvard and a staff writer for The New Yorker, these clinical episodes make absorbing reading and are often deeply affecting. At the same time, the author is commenting on some of the most profound problems facing modern medicine.

Historically, medical education has regarded communication skills with an indifference that approaches contempt. His stories show us instances where a doctor makes snap judgments that are wrong — and right; where past cases distort present perception; where rapport with, or dislike for, a patient alters diagnosis or care.

But he is critical of much of the thinking now in vogue. This is intended to produce better diagnoses and fewer errors; it is also embraced by insurance companies, who use it to decide which tests and treatments to approve. But for difficult cases he finds it limiting and dehumanizing.

He is similarly critical of generic profiles, classification schemes that draw statistical portraits of disease states. They encourage the doctor to focus on the disease, not the patient, and so may lead him to miss the particular manifestation in the particular sufferer. This means that young doctors enter the hospital knowing little about either the advantages or the disadvantages of heuristics.

Before departure, the baby was coughing. On landing, she seemed dehydrated and refused to drink; a day later she was in the I. Her doctors, recognizing they might be up against an exotic infection from Vietnam, struggled to oxygenate her, but even on the respirator her condition deteriorated. Saved from death by extreme measures, she was found to be infected by five potentially lethal agents: pneumocystis, cytomegalovirus, Klebsiella, Candida and parainfluenzae.

Such devastating multiple infections implied an immune deficiency. SCID is a rare, inherited condition. After more than a month in the I. With the child improving, Rachel conducted her own research on SCID, becoming ever more convinced that her daughter did not have it. Instead, she suspected Shira had a nutritional deficiency. Rachel stubbornly insisted that immune testing be repeated, and the pediatricians reluctantly indulged her.

The bone marrow transplant may well have killed her. By contrast, Boston doctors have little experience with unusual nutritional deficiencies. Contradictory evidence is brushed aside. I made faulty assumptions, seeking to make an undefined condition conform to a well-defined prototype, in order to offer a familiar treatment. It is this direct and honest voice that drives the narratives of this remarkable book. Here is Groopman at the peak of his form, as a physician and as a writer.

Readers will relish the result. Home Page World U.


How Doctors Think

Valuable to folks who want to be an active participant in managing their health. Easy to read and also thorough - more than a pop self-help book. Scary, but fascinating. It reinforces my experience that the most confidence-inspiring physicians are those who are willing to say, "I don't know" when they don't, rather than, "Oh sure, I've got that covered," when really they're clueless. Jerome Groopman, M. How Doctors Think.


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