How Doctors Think [Hardcover]

Starred Review. SignatureReviewed by Perri KlassI wish I had read this book when I was in medical school, and I'm glad I've read it now. Most readers will knowJerome Groopman 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.But this book is something different: a sustained, incisive and sometimes agonized inquiry into the processes by which medical minds—brilliant, 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: "[m]ost errors are mistakes in thinking. And part of what causes these cognitive errors is our inner feelings, feelings we do not readily admit to and often don't realize." Attribution errors happen when a doctor's diagnostic cogitations are shaped by a particular stereotype. It can be negative: when five doctors fail to diagnose an endocrinologic tumor causing peculiar symptoms in "a persistently complaining, melodramatic menopausal woman who quite accurately describes herself as kooky." But positive feelings also get in the way; an emergency room doctor misses unstable angina in a forest ranger because "the ranger's physique and chiseled features reminded him of a young Clint Eastwood—all strong associations with health and vigor." Other errors occur when a patient is irreversibly classified with a particular syndrome: "diagnosis momentum, like a boulder rolling down a mountain, gains enough force to crush anything in its way." The patient stories are told with Groopman's customary attention to character and emotion. And there is great care and concern for the epistemology of medical knowledge, and a sense of life-and-death urgency in analyzing the well-intentioned thought processes of the highly trained. I have never read elsewhere this kind of discussion of the ambiguities besetting the superspecialized—the doctors on whom the rest of us depend: "Specialization in medicine confers a false sense of certainty." How Doctors Think helped me understand my own thought processes and my colleagues'—even as it left me chastened and dazzled by turns. Every reflective doctor will learn from this book—and every prospective patient will find thoughtful advice for communicating successfully in the medical setting and getting better care.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 the book an immediacy and an eloquence that will resonate with anyone interested in medicine, science or the cruel beauties of those human endeavors which engage mortal stakes. (Mar. 19)Klass is professor of journalism and pediatrics at NYU. Her most recent book is Every Mother Is a Daughter, with Sheila Solomon Klass.
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

By far the largest number of examples New Yorker staff writer and Harvard physician Groopman adduces to show how doctors think shows them thinking well for the good of their patients. In the initial example, one doctor seen by a woman with a long-standing weight-loss condition concedes being stumped and sends her to a specialist who finds the cause of her woes and, most probably, saves her from an early death. Both physicians are praiseworthy, the second more than the first only because he believed a patient whom others had come to pooh-pooh as a complainer and then thought of examining for something that the others had missed. The lesson? A doctor has to think with the patient, not despite or against her or from an assumption of superior knowledge. Subsequent chapters show doctors thinking in resistance to economic pressure by hospitals and insurers, in thorough solidarity with parents about their children's care, against a host of professional assumptions and in resistance to pestering by drug companies--all to help patients achieve their own goals as far as possible. An epilogue suggests a few questions patients should ask to help their doctors think clearly and, as the last chapter's title puts it, "In Service of the Soul." A book to restore faith in an often-resented profession, well enough written to warrant its quarter-million-copy first printing. Ray Olson
Copyright © American Library Association. All rights reserved

Starred Review. SignatureReviewed by Perri Klass I wish I had read this book when I was in medical school, and I'm glad I've read it now. Most readers will knowJerome Groopman 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.But this book is something different: a sustained, incisive and sometimes agonized inquiry into the processes by which medical minds—brilliant, 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: "[m]ost errors are mistakes in thinking. And part of what causes these cognitive errors is our inner feelings, feelings we do not readily admit to and often don't realize." Attribution errors happen when a doctor's diagnostic cogitations are shaped by a particular stereotype. It can be negative: when five doctors fail to diagnose an endocrinologic tumor causing peculiar symptoms in "a persistently complaining, melodramatic menopausal woman who quite accurately describes herself as kooky." But positive feelings also get in the way; an emergency room doctor misses unstable angina in a forest ranger because "the ranger's physique and chiseled features reminded him of a young Clint Eastwood—all strong associations with health and vigor." Other errors occur when a patient is irreversibly classified with a particular syndrome: "diagnosis momentum, like a boulder rolling down a mountain, gains enough force to crush anything in its way." The patient stories are told with Groopman's customary attention to character and emotion. And there is great care and concern for the epistemology of medical knowledge, and a sense of life-and-death urgency in analyzing the well-intentioned thought processes of the highly trained. I have never read elsewhere this kind of discussion of the ambiguities besetting the superspecialized—the doctors on whom the rest of us depend: "Specialization in medicine confers a false sense of certainty." How Doctors Think helped me understand my own thought processes and my colleagues'—even as it left me chastened and dazzled by turns. Every reflective doctor will learn from this book—and every prospective patient will find thoughtful advice for communicating successfully in the medical setting and getting better care.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 the book an immediacy and an eloquence that will resonate with anyone interested in medicine, science or the cruel beauties of those human endeavors which engage mortal stakes. (Mar. 19)Klass is professor of journalism and pediatrics at NYU. Her most recent book is Every Mother Is a Daughter, with Sheila Solomon Klass.
(Publishers Weekly )

By turns inspiring and dismaying, [the book] explains how even the best doctor can draw the wrong conclusion, and why that same doctor might also come up with a brilliant diagnosis that has eluded his peers. Uncertainty hovers over the practice of medicine, which Dr. Groopman, a clear writer and a humane thinker, presents as an art as well as a science, despite the spectacular advances in medical technology. (The New York Times - William Grimes ) --This text refers to the Paperback edition.

On average, a physician will interrupt a patient describing his symptoms within twelve seconds, in that short time, many doctors decide on the likely diagnosis and best treatment. Often, decisions made this way are correct, but at crucial moments they can also be wrong—with catastrophic consequences. In this mythshattering book, Jerome Groopman pinpoints the forces and thought processes behind the decisions doctors make. Groopman explores why doctors err, and shows when and how they can—-with our help—avoid snap judgments, embrace uncertainty, communicate effectively, and deploy other skills that call profoundly impact our health. A doctor’s specialty, the technology he relies on, his age and his emotional state can all produce different sorts of mistakes, and few doctors are trained to think about how they think—to recognize when their cognition is going astray. This book is the first to describe in detail the warning signs of erroneous medical thinking, offering direct, intelligent questions patients can ask their doctors to help them get back on track. In unraveling the sources of faulty diagnosis and treatment, Groopman draws on a wealth of research, extensive interviews with some of the country’s best doctors and his own experiences as a doctor and as a patient. He has learned many of the lessons in this book the hard way, from his own mistakes and from errors his doctors made in treating his own debilitating medical problems. How Doctors Think reveals a profound new view of twenty-first-century medical practice. giving doctors and patients the vital information they need to make better judgments together.

Jerome Groopman M.D., holds the Dina and Raphael Recanti Chair of Medicine at Harvard Medical School, and is Chief of Experimental Medicine at Beth Israel Deaconess Medical Center in Boston. He has published more than 150 scientific articles. Much of his research has focused on the basic mechanisms of cancer and AIDS. His previous books include the New York Times bestseller The Anatomy of Hope, Second Opinions, and The Measure of Our Days. The television series Gideon’s Crossing was based on The Measure of Our Days and Second Opinions. He is a staff writer at The New Yorker, and has authored several editorials on policy issues in the New Republic, the Washington Post, and the New York Times.

Yes, we hear about how doctors think, but Dr. Groopman's lessons encourage everyone to examine how they reason and come to conclusions. Using engaging patient histories and simple language to explain complicated medical concepts, the author makes his instruction in cognition pleasant to hear and easy to understand. Michael Prichard adapts his narration to make himself sound interesting and interested. His reading rhythm and pace find just the right combination to make every word audible and understandable. Although he fluffs the pronunciations of a few medical terms, no one but a physician will notice. The fact that Prichard doesn't sound scientific may increase the audiobook's appeal to general readers who want to improve their ability to think logically when making decisions. J.A.H. © AudioFile 2007, Portland, Maine-- Copyright © AudioFile, Portland, Maine --This text refers to the Audio CD edition.