I accidentally stumbled upon Jerome Groopman's book, and picked it up figuring it might be worth reading. As a science researcher who's considered attending medical school, Dr. Groopman's book was insightful in confronting the many problems affecting physicians and medical schools today. After several chapters of meaningful stories, I came to chapter 5, `A New Mother's Challenge". I wish I had skipped this chapter.

Groopman begins by explaining the story of a woman, Rachel, who adopts a baby from Vietnam. This child is found with a severe immunodeficiency of unknown causes. Throughout the chapter, Groopman explains how Rachel, (whom we later find he met in their local synagogue), falls back on God and her faith throughout her new baby's ordeal. We later find Rachel thanking God for saving her child's life on September 11, 2001.

Of course, this was the same day some of God's most faithful flew two planes into the World Trade Center in His name, killing thousands of innocent people. Yet amazingly as a clinician and scientist, Groopman seems to continue to preach faith at the end of the chapter, failing to recognize that what saved this baby's life is the rational human mind (even if it is fallible at times) . The research scientists who studied science for years to develop laboratory tests to diagnose the illness, the physicians and nurses who applied medical science knowledge in their care of the baby, and ironically the mother Rachel, all guided the doctors to the right diagnostic answer to save her baby's life. YET it is this unknowable metaphysical `God' who gets thanked time and again for her baby's survival?? Besides this unfortunate, and unnecessary, preaching that undermines the flow of the book, Dr. Groopman's tales are of great value in learning the difficult decisions and potential cognitive errors medical doctors can face everyday. It arms the lay reader with great insights into practical ways to discuss a loved one's health and one's own health with their physicians.

When Dr. Jerome Groopman began his medical internship at the Massachusetts General Hospital, he placed a high priority on facts. While in medical school he had tirelessly tried to "store an encyclopedia in [his] mind" as so that when faced with patients, he could "open the mental book and find the correct diagnosis and treatment." Thirty years later he saw students and residents relying on statistics, algorithms, "evidence-based" guidelines -- tools he feared would shackle their cognitive processes. How do doctors think, he wondered? How SHOULD they think?

This book is the product of his thoughtful consideration of those questions. He read the available research and spoke with many colleagues about their theory and experience, assembling cases to illustrate his findings. There are many ways a doctor can fall into errors of cognitive process. Representativeness error matches the patient against a prototype and fails to consider other possibilities: a fit, active man is probably not having a heart attack. Attribution error leads a doctor to categorize the patient negatively: the disheveled patient with edema and an enlarged liver is probably an alcoholic. Affective error prevents the doctor from looking beyond favorable indicators for a liked or admired patient. These and other errors are based in social assumptions and pattern recognition, and in the general rule that when you hear hoofbeats, you should think of horses, not zebras. In these days of managed medicine, there is bias toward a linear approach and "satisfaction of search" -- settling for the first answer that reasonably accommodates the available data.

The detailing of these and other cognitive errors and shortcuts actually forms a small part of How Doctors Think. Dr. Groopman goes on to discuss situations where errors of thinking are likely to occur: the reading of X-rays and CT scans, the impact of marketing on medical decision making, the roles of variability and uncertainty in treating babies with malformed hearts, the treatment of cancer. The patients and their stories are well integrated with Dr. Groopman's discussion of his subject: how to partner with the patient for the best possible outcome.

This is not a book of medical horror stories, nor of doctor-bashing; not even of managed care-bashing. It's a measured exploration of the doctor's role, with a final chapter offering advice to patients on questions they might ask their doctors. Required reading for all parties in the health care team. Yes, that means you!

Linda Bulger, 2008

Dr. Groopman really delves into how doctors come to certain conclusions about a patient's diagnosis. He reviews various case studies and interviews various doctors to clearly drive the message that doctors need to think differently and patients need to ask questions that will enable doctors to think differently. He also mentions some questions that patients can ask to get a doctor to channel his or her thinking elsewhere. I highly recommend both patients and doctors read this book.

This subject is very dear to my heart because I spent over four years being misdiagnosed until I found a doctor who discovered the problem. Once discovered, my insurance company refused to pay for an operation I needed because they felt I was new to this "diagnosing" doctor and he hadn't tried enough drugs to cure me even when many of the other doctors had prescribed the same or similar drugs in the past without any results. I had taken my case to the Independent Physicians Review Board (IPRO) which is at the state level and the last resort for HMO rulings to be overturned. They even ruled against the operation and said I needed to try more drugs. What was interesting was that the operation was also suppose to fix a structural defect in addition to everything else. Since when are structural defects cured by drugs? I called IPRO on this and got the response (after several weeks) that they didn't know that was a problem.

I hope Dr. Groopman writes a sequel to this book on how insurance companies perpetuate the suffering related to how doctors are thinking. In essence insurance companies are also "diagnosing" problems incorrectly without ever seeing the patient by disagreeing with a doctor's conclusion (via paperwork) and what the doctor's recommended treatment should be.

I recommend you take charge of your health care and learn the pitfalls doctors and patients fall into. What an excellent book in my opinion.

As an MD and ocxcasional patient, I think this book is a must for all of us. I gave it out as a present to my MD friends, to my private physician and to a cousin who is a very knowledgeable RN. This book is written with modesty, humor and empathy, things which some of us lack. I am not sure that all lay people will get the gist of it, but I recommend it highly.

When we're sick, we want to believe the doctor knows best. With authority and confidence, they assess our symptoms and assign a course of treatment, and we go along, perhaps anxiously but comforted by their wisdom just the same.

In "How Doctors Think," Jerome Groopman (himself an oncologist for decades) reveals how rarely doctors are totally sure of their diagnoses--and how when they are, it may be the biggest problem of all. Doctors, like all of us, are prone to thinking errors; for example, they may jump to the most obvious conclusion, or stop thinking when they find "the answer," or any number of other common pitfalls. But when doctors stop thinking, it can result in harm to the patient. Groopman's book explores how and why these mistakes happen, and the consequences they can have.

Luckily, it's not all bad news: far from trying to cast aspersions on the reliability of the medical profession, Groopman firmly believes that doctors can not only train themselves to avoid thinking errors, patients can help them by asking pointed questions during an exam or follow-up. (Groopman touches on such questions throughout, then summarizes them in a brief epilogue.)

Groopman is undoubtedly a doctor before he is a writer, but his style is good-natured, and a wealth of real-life examples makes his sometimes abstract subject matter engaging. "How Doctors Think" is a sometimes surprising, sometimes disturbing, but ultimately optimistic discussion of the ongoing art form that is modern medicine.

~

this book review is mostly about me and not about the book's contents, but it is about doctors.

I have gotten some feedback recently, over the last year, implying that I have a tendency to blame doctors for my problems. and I thought about it and I have to admit that is true.

I have various disabilities and etc. my issue in particular is that due to a cognitive impairment, I go through a process of mental churning when I think through things. it is a feeling of dizziness and pressure in my head. and in the past I have fought that in a way that has negatively impacted other people, in this case, doctors. I do feel bad about that and I understand that I will need to be extremely careful.

my husband is the most fair judge of this and he said that I tend to assume I won't be listened to and then panic. and for example, when I was in the hospital, he said that I continued a conversation he and I were having instead of talking to the doctor.

and I thought about it and I have to admit that is true. I do have a tendency to do that. to assume things will go badly and panic.

my concern is that this book is written with the same negative type slant.

after thinking about it for quite some time, I decided I needed to face my fears and so I am working on it. my fear is that doctors are uncaring and threatening.

the problem is, in the many years I've had appointments, is that I have been living out that fear instead of facing it.

I have to admit that I have tended to think quite a bit of other people's perspectives and that has sometimes led me to a tendency to blame them - it is not always instead of taking responsibility, but in addition to it.

and that is really not OK. I am finding it has a bad effect on people, including the doctors I have been seeing in some cases. :(

the problem is I had a brain injury which means my insight and memory are compromised. the difficulty is that I tend to blame doctors in particular, to fill in the gaps of what I do not understand.

I did think about this feedback I received. sometimes I don't think in time to avoid saying stupid things. but I did think about it, b/c it let me know that something is wrong.

it can take me 5 or 6 solid hours of lying down and doing nothing but thinking through an issue like this to get to a conclusion. I believe the moral is that I need to think before I speak, or type. :)

I hope that this way, my fear and anxiety will be less.

I had a doctor's appointment today. I was really nervous but it went very well. I had a lot of fear and the doctor, who was my allergist, was patient and understanding.

The most powerful messages I got from reading Groopman's How Doctors Think are related to his positions on treatment algorithms and practice guidelines and health care quality.

While many medical professionals consider evidence-based medicine the gold standard of medical practice, Groopman expressed his concern about the detrimental effect it has on doctors' ability to think independently and creatively. He reasoned that strictly adhering to algorithms debilitates doctors' ability to think outside the boxes and limit them from taking into consideration the idiosyncrasy of each individual patient.

Groopman also argued that "quality in primary care means much more than using metrics to judge a physician's quality or keeping a scorecard to ensure blood sugar was messaged and a flu shot given." He gave quality of care a new definition: "Quality means thinking broadly, because any and every problem of human biology can present itself; it means making judicious decisions with limited data about children and adults, neither overreacting nor being blasé; it means wielding one's words with precision and with a profound appreciation of the social context of the patients. It means, as a gatekeeper, knowing where to guide us. One of those portals opens to the intensive care unit."

After reading Groopman's viewpoints on evidence-based medicine and quality of care, I can't stop wondering whether the "Pay-for-Performance" program which offers physicians financial incentive for providing "quality of care" based on predefined quality measure target(s) that are in alignment with certain evidence-based clinical guidelines is the direction our nation should follow.

It is disconcerting to find that our current health care reimbursement structure is the hidden cause of some of these cognitive errors. In an era of managed care, many physicians are stretched thin and burned out. They are pushed to see more patients in shorter duration. Under time constraint, physicians are forced to make snap judgment. It is inevitable that they commit cognitive errors or biases (from representative, affective, availability and satisfaction of search error, to confirmation, anchoring and commission bias) because of the time pressure. The cost-driven system also forces them to make decisions based on cost control rather than the best interest of the patients. The fee-for-service payment mechanism reimburses physicians better for procedure rather than consultation, so they will prescribe unnecessary procedure to increase revenue.

Among the many stories in the book that have left lasting impressions on my mind, the one that struck me the most is his narration of his first patient encounter thirty years old on his first day of internship at the Massachusetts General Hospital. He described himself as an intense, driven student carrying a pack of index cards from medical school in his pocket. During his first encounter of emergency medicine in the "real world," he faced a hypertensive patient with a tear through his aortic valve. He tried to think (and response) but couldn't. He was stunted and paralyzed. In this critical moment when it required his "flesh-and-blood decision-making," he failed to make a prompt response. This reality check taught him that his high grades in medical school were meaningless. The index cards in his pockets were just dead weight. It may be hard to believe, but even people who are highly intelligent (and full of confidence) may have difficulty making prompt decision in split second.

Another story that is as intriguing is the incident in which he failed to ask him to roll over so he could examine his buttocks and rectum simply because he felt for his patient and didn't want to cause him extra suffering. He thought he should have examined him more thoroughly and he berated himself for doing a sloppy job. He learned that "physicians must learn to suppress their emotions, to block their natural reactions to many of the awful things they see and the brutal thing they must do to their patients. They have to detach themselves from anguish that could impede their work." It is important to note how our emotion may impede our work performance.

I highly recommend this book to medical students, residents and medical professionals, who will find in this book many invaluable lessons on how to avoid cognitive errors and biases. I will recommend this book to patients, their families and friends, who will find in this book many helpful tips on helping their physicians avoid cognitive pitfalls.

I am an R.N., and thought I knew how my fellow medical people, the doctors, thought. They acted in unusual ways at times, but I didn't know why. This book is a portal into the ways that the people who hold our lives in their hands, come to some of the decisions that they make. I recommend it highly to all. You don't have to be in it (the medical profession) to be aware. At some time, sooner or later, we and our families and friends become ill. At that time, we all need doctors. It is good to know a little more of their training, and what might make them tick in a certain way. It is well-written, and makes many valid points.

As a clinician in the aftermath of making a cognitive error, I found Dr. Groopman's book inspiring. It has opened my eyes to blind spots in thinking and how emotions play a bigger part than we want to admit. Reading this book has given me insight about how the very things that are strengths if taken to the enth degree can be a weakness.

This book is relevant not only for the clinician who wants to improve, but for patients who want to learn how to best communicate their needs in a way that gets the attention and focus of the clinician from the moment they say enter into that delicate relationship and allow a stranger to examine their most intimate selves.

Excellent book: Sharp, clear, and easy to read.
One of these books that do not last on the shelf because there is always someone reading it in the family or among your friends.

Dr. Groopman is an eminent and wise physician who has written this honest and incisive book on "how doctors think." The emphasis is on how they are subject to errors and omissions in perception, reasoning, decision making, communication, and action, but examples are also provided of excellent performance in which these sorts of errors and omissions are avoided.

Dr. Groopman is an excellent writer, so the book is easy and enjoyable to read, and never gave me that feeling of "just wanting to get it over with."

I think the book would have been better if some of the key non-medical terms (eg, "premature closure" and "framing effect") were italicized in the text and included in a glossary. I would also have liked to see a summary of key points, in bullet-point format, at the end of each chapter. However, even as is, the book still warrants a full 5 stars.

There is actually an extensive literature addressing these issues in depth, in a general way which covers all fields of endeavor, but Dr. Groopman doesn't seem to be aware of this literature. See for example Human Error. Therefore, the particular contribution of this book is that it applies all of this in the setting of medical practice in an easily understood way. For that reason, this book is a must read for everyone: people need to have a realistic sense of the capabilities and limitations of their doctors, so that they can work with them effectively and improve outcomes.

I also highly recommend Dr. Groopman's book The Anatomy of Hope: How People Prevail in the Face of Illness, which is excellent in audio form (masterfully read by Dr. Groopman himself).

Dr. Groopman's insightful book provides valuable insights into the process by which an individual becomes a mature physician and learns to think like one. In today's world, that necessitates rapid turnover of patients and thought processes dictated by medical guidelines and payment schedules which discourage creativity and out-of-the-box thinking. This incisive work provides insights into the thought processes of physicians in making a diagnosis, and how physicians learn to think in that manner. The material is both interesting and pragmatically important for everyone who utilizes physicians and those who should. I found this book invaluable, since I am both a physician and one of those individuals who almost died due to misdiagnosis.

Dr. Groopman is an eminent and wise physician who has written this honest and incisive book on "how doctors think." The emphasis is on how they are subject to errors and omissions in perception, reasoning, decision making, communication, and action, but examples are also provided of excellent performance in which these sorts of errors and omissions are avoided.

Dr. Groopman is an excellent writer, so the book is easy and enjoyable to read, and never gave me that feeling of "just wanting to get it over with."

I think the book would have been better if some of the key non-medical terms (eg, "premature closure" and "framing effect") were italicized in the text and included in a glossary. I would also have liked to see a summary of key points, in bullet-point format, at the end of each chapter. However, even as is, the book still warrants a full 5 stars.

There is actually an extensive literature addressing these issues in a general way which covers all fields of endeavor (which Dr. Groopman doesn't really seem to be aware of), so the particular contribution of this book is that it applies all of this in the setting of medical practice. For that reason, this book is a must read for everyone: people need to have a realistic sense of the capabilities and limitations of their doctors, so that they can work with them effectively and improve outcomes.

I also highly recommend Dr. Groopman's book The Anatomy of Hope: How People Prevail in the Face of Illness, which is excellent in audio form (masterfully read by Dr. Groopman himself).

This is a very thoughtful book. It really makes you think. It gives us a clue about universal health care.

What this book does through the powerful tool of story-telling is both inform and empower us to become active participants in our own health care. I have a chronic illness that was repeatedly misdiagnosed (and thus inappropriated treated) for years.

As I read this book, I began to understand how that process came about. I also began to see the individual physicians involved as more fully human, and to be able to forgive them for the errors they made, even those made out of arrogance. Frustrated, I was lucky (and stubborn) enough to keep questioning and searching until somebody could answer my questions, evaluate my condition with and open mind, and provide an accurate diagnosis.

Since then, appropriate treatment has allowed me to "recover" my life from living as an invalid, and again become an active partipant in my own life. But my illness was not inevitably chronic: as a result of the delay in diagnosis, I will always live with its aftermath, and always be vulnerable to relapses. I wish I'd had a book like this to guide me through the process of questioning and discovery: it might have taken less than the 16 years it did.

The mysterious reviewer who hides behind the name "The Doctor" (an arrogant stance in itself) takes exception to this book for the way it is written and for the fact that it uses anecdotes. This book is not a scientific treatise: it could not do its job if it were written as one. As a scientist myself, I know that while anecdote cannot stand as proof, it can stand in as illustration and example. Anecdote is one of the many ways humans transmit experience and wisdom, and make it meaningful at a personal level. It is entirely appropriate in Dr. Groopman's book.

"How Doctors Think" is a series of anecdotes by various doctors, interviewed by the authour, with the underlying theme of when/why/how doctors can make mistakes.

In the sense that it gave me insight into what really goes on behind the appearance of infallible expert, the book was fascinating. The authour talks about why doctors sometimes give you a multitude of answers, misdiagnose, rush, or don't seem to care, by giving you the doctors' perspective on the situation.

There are two aspects I didn't care for, both closely related. Mind you, I got the book for insight into the doctor's life and nothing more.

The first is the advice to the patients, where the authour tries to advise patients on what they can do to "help" the doctor avoid misdiagnosis. Encouraging patients to question the doctor or try to coach lateral thinking won't be effective for all doctor-patient relationships or situations. I happen to like asking doctors questions, for my own edification, but I don't know if that would work for everyone.

The second is the apparent theme to doctors, to be aware of potential for cognitive errors, and examples of how other doctors handle themselves to reduce the chances of those cognitive errors. Mildly intersting, but too much time spent on it considering I'm not a doctor and I imagine most readers wouldn't be either?

Overall, though, I learned a lot about life in a doctor's coat, and that makes it a great book for me.

Author brings his vast experience as a physician and looks into odds of suviving in present day health care system. Good read for everyone who wants to understand the issues in Physician-Patient relationship.

The seed for the idea of this book was planted several years ago while Dr. Groopman was in the course of supervising interns, residents, and medical students on rounds in a teaching hospital. While conducting the rounds in a customary manner, Dr Groopman became disillusioned by the responses of his charges. While these were unquestionably intelligent and educated students of medicine, he observed a failure in their ability to question, listen, and observe. At that point, as their instructor, he began to question how doctors are trained to think about their patients and the patients' problems.

This book delves into the traditional methods that doctors have used to make decisions, as well as many of the problems that currently face the health care industry and the ways in which they interfere with the doctor and patient relationship. In today's world, the doctor must not only do the best possible job for his patient , but also comply with insurance companies, lawyers, algorithms, and flowcharts. Historically, doctors have learned as "apprentices" to other doctors by observing, doing, and teaching. But, even with the advances of modern medicine, doctors are still required to make many judgment calls. Medicine is never an exact science.

Another area that is explored is Doctor/patient communication. Inability to engage the patient in meaningful dialogue is one of the problems encountered. Another problem in "doctor thinking" is falling back on stereotypical thinking and not approaching the patient's problems as a unique circumstance.

The book also details the pitfalls that doctors can enter into by not evaluating their diagnostic processes. Fatigue, fear of failure, and interpreting data inappropriately are but a few. A physician by nature refers to his own area of expertise when evaluating a problem. For instance, if a patient visit's a surgeon, the surgeon looks at the patient as a surgical candidate. This is a generalization, but in a nutshell, a doctor wants to use skills with which he is most familiar. Dr. Groopman also calls attention to the influence of the doctor's decision on the "last bad experience". A fear of repeating an error sometimes clouds the judgment of the practitioner.

As a practicing health care provider, I found this book to be pleasantly readable and very informative. The book is not, however, written at a level that an average patient would be able to understand. The vocabulary is at a college level, and the writer assumes at least a basic understanding of medical terminology and anatomy. In one case, I was baffled by a reference to Sisyphus. Which mythological character was this and what was his dilemma? (The text referred to a physician that felt like Sisyphus when he encountered patients that did not care for themselves. Sisyphus was in fact the being that tried to roll the boulder up a giant hill.)

While How Doctors Think is a worthwhile read that provides great insight to how doctors are trained and the many challenges they face, I am skeptical that this book will improve communication and outcomes for the average patient.

The book I ordered came promptly, was packaged well, and was in pristine condition. I was very pleased.

I had checked out a copy from the library. A friend who had recently had to deal with her parent's illnesses started reading it and couldn't stop. So I bought a copy for her. It is worth having on hand as it has many ideas about dealing with doctors and knowing when to support, question, review or seek other ideas. Some of their thinking reflects the training of medical school and it is helpful to know why certain patterns of thinking are so prevalent.
I also appreciated the chapters on reading xrays, tests, etc. and how much that can vary from expert to expert or time to time. It makes me realize that if I don't put effort into my doctor's analysis, I may well get an inaccurate one.

Groopman brings a refreshing account concerning the cognition abilities of physicians and its residual affects upon their patient interactions. He conveys that physicians inadvertently rely upon their initial professional socialization processes while in medical school by learning different matrices in determining diagnoses. That this mindset is ingrained with some physicians does reflect negatively on patients with deleterious effects. Especially, as these physicians becomes more entrenched in the course of their medical careers, in terms of his/her professional demeanor and acumen. That external forces also influence these purportly medically derived diagnoses: indifference, reimbursement, and conflict of interest. He infers that reluctancy exists among some physicians in delving into the diagnosis, treatment and prognosis for their patients. This grays the physician-patient relationship that the latter believes about the former.

Chapter nine really illustrates the effect of the pharmaceutical industry upon physicians. Groopman states that there is a definite need for pharmaceutical research in exploring effective medications, but delineates that ethical standards are circumvented. He places the reader's perspective into the mindset of physicians by illustrating their practical terminology and analysis matrices. This is an excellent read for researchers, physicians, medical ethicists, social scientists and students to gain further insight into the cognitive reasoning by physicians as they conduct formulate and conclude medical diagnoses.

Interesting and insightful look behind the scenes when you have a potentially very serious medical condition

As a family doctor, I felt compelled to read this text. It was more like a compliation of ideas and stories and life experiences, which was not what I expected. It did not have any novel ideas, but was worth reading.

This is a useful guide for everyone and anyone who needs to see a doctor for whatever reason. It is also a practical guide filled with useful information on how doctors think. Not only does it focus on doctors, they focus on radiologists, internists and more. This book points out the differences that doctors face when they leave medical school and enter the working force.

It is simply fascinating. It is also disturbing in a way especially if you already don't have faith in your doctors. Groopman shared his own experiences with doctors when he had to be treated for his wrist that has been bothering him. He had to see three different specialists with three different solutions and finally arrived at a conclusion that was successful for him. But it took over a period of time before he was satisfied.

He provides examples of doctors who actually think outside the box as well as doctors who don't. He also provides examples after examples of patients who succeed in getting better or didn't succeed because they didn't listen to the right doctor or let fear get in the way or whatever.

The point of this book is that doctors are just as human as the rest of the world, and that makes them fallible in a field where everyone wishes they were not fallible. It also serves as a reminder that medicine is not an exact science even though there have been progress made over the last 200 years, and in the last 2 decades alone. There is still much out there that are the unknown and doctors are navigating their way through it as well as the patients. Sometimes they succeed, and sometimes, they don't.

This is a very thorough and insightful book and an useful one for all patients in perhaps in asking the right kinds of questions while searching for the answers. This is a keeper in my library.

4/21/08

The book starts out quite interesting and has a topic that many can relate to--what happens when doctors are wrong? Unfortunately, the entire book seems to say on the topic of telling stories about doctors making mistakes. Half the size of the book could be cut down if Groopman simply omitted the tedious amount of repetition in his stories.

The book arrived in great shape. It is well written by a doctor who attempts to reveal the processes that doctors go through making diagnoses and treating patients. It is an honest look at some of the pitfalls of modern physicians, as well as cases where they did it right or failed to recognize the true problems.

The good doctor has indeed placed the issue of medical decision making within the larger subject of decision making in general. He has provided a helpful window into the world of "in-the-trenches" practice. The academic setting he reflects, as do most of his examples, allows for more introspection and categorization than the hurley burley of most community practices. The lessons, none the less still apply generally. This book will be valuable to physicians, patients, and to those tasked with quality assurance activities in medicine.

An intelligent, informative, well written answer to the question I have always had. Being an individual who mistrusts most doctors I found this information helpful in that I now know what questions to ask and how better to make my own decisions in my health care. We all need to be our own health care advocate to get the best medical care possible. This book is a fine tool to that end. I plan to give one to every major doctor I have to do business with.

Having retired 11 years ago after a lifetime of nursing experience, I appreciated the stories and transparency of this volume. It resonated with my experience "on the front" and made plain so much I had observed and witnessed. Arrived in good condition, in fine time.

I now learned how to ask my doctor succint questions relating to my symptons within the 5-7 minutes minutes allowed by my insurance career.

Fascinating read and written in the same spirit as Malcolm Gladwell's Blink. Dr. Groopman investigates how doctors make misjudgments and misdiagnoses because of their failures to understand and acknowledge cognitive limitations and errors in thought that affect all of us and unbeknownst to us. He feels that if doctors take a step back, are introspective and insightful about these deficiencies and take appropriate steps to minimize these problems, we can be better clinicians. The doctors he profiles are truly inspirational, remarkable, and masters in their fields, not only because of their medical knowledge, but because of their recognition of what it takes to be superb people and clinicians.

If there is an area of disagreement, then it is the fact that Dr. Groopman suggests that the pressures of managed care and inadequate time are the cause of many of these cognitive errors. Yet, he never actually proved this in the book. He never showed that doctors were more likely to make the correct diagnoses in an era with fewer time constraints. In fact, he laments that doctors in training, where he teaches at Harvard, don't know how to think and then realized that he hadn't be trained how to think either over thirty years earlier (and hence the reason for his investigation and this book). He claims that quality of medical care shouldn't be simply defined as whether or not a patient with diabetes has his blood sugar checked routinely, but Dr. Groopman also doesn't acknowledge that the major reason the United States ranks last in the world in keeping people healthy it is because the quality of care delivered never was measured as carefully as it is today. Research shows that 80,000 Americans die prematurely (twice the number of breast cancer deaths) simply because the right preventive care wasn't delivered. Had the nation adopted those health insurance plans, hospitals, and doctors, who performed at the top 10 percent of providing this care, these individuals would be alive today. How do they do so well? It is because of implementation of systems that promote excellence. As a practicing primary care doctor I understand the concerns of my colleagues of showing and proving that they are doing what they say. But we all know if you don't measure something and then re-evaluate it, how do you know if you are doing better? If anything, Dr. Groopman seems to suggest that medical care would be better if doctors didn't have to prove that they performed these metrics to the level of what the evidence shows to be effective even though other industries like financial services, manufacturing, and the airline industry do so rigorously to maintain their high levels of reliability, consistency, and safety.

Although he encourages patients be advocates for themselves, to ask questions, and how to slow a doctor down and think more clearly with certain comments, from his own examples it is clear that it isn't easy to do and frankly somewhat intimidating. The book Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America's Healthcare System has more practical tips and suggestions on how to get the right care.

If there is a lesson to be learned, then it is that as doctors we need to understand that our thought processes can be clouded by emotions and can be limited simply because we too are human. To overcome this problem, which affects all of us, we need to be deliberately thoughtful and systematically introspective when caring for patients. As a practicing primary care doctor, I believe that we, not the patients, bear this responsibility and that I hope doctors in training are being taught this routinely in this country and that others welcome the opportunity to do better. While it should be a required reading assignment for medical students, interns, residents, and practicing physicians, better thinking doctors alone aren't going to improve healthcare quality in the United States. Dr. Groopman's subtle suggestions that they might are simply his error in thinking and his inability to remain open-minded and see that the world he trained in is far different than the world his trainees are about to enter.

Dr. Groopman has written an important and relevant work on the mechanics of the doctor-patient relationship. A participate in a seminar I provide recommended this work in response to my observation during the seminar that people, by and large, analysis data more than they synthesize data. The gist of the idea is that we tend to deconstruct/deduce more than we construct/induce data. Dr. Groopman's work supports this hypothesis in the excellent examples and illustrations of actual doctors working with real patients. He discusses the intellectual/ethical/economic difficulties doctors face when they "think outside the box", and the real constraints of limiting their relationships/diagnosis to deductive reason exclusively.
I highly recommend this book to anyone---we all visit the doctor, and we count on the doctor making us better and helping to improve the quality of our lives. Dr. Groopman provides the layman insight into the competing priorities and the "baggage" of traditional thinking many doctors continue to employ, and demonstrates the enormous potential for doctors and their patients when the doctor thinks, listens, and treats the patient as a whole, not just the obvious symptoms. Human beings are amazingly complex and the solutions to our problem oftentimes requires intellectual insight beyond the simple---insight beyond the norm. The examples are wonderful, inspiring, and in some cases scary---but if you care about how your doctor arrives at conclusions and treats you, this book will be indispensable.