From Publishers Weekly
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.
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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
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