How Do Physicians Know?

Medical Dispatches

What’s the Trouble? How doctors think.

by Jerome Groopman January 29, 2007

http://www.newyorker.com/reporting/2007/01/29/070129fa_fact_groopman?printable=true

The physician who authored the above article has also published a book,
http://www.amazon.com/How-Doctors-Think-Jerome-Groopman/dp/0547053649/ref=ed_oe_p
How Doctors Think (Paperback - "coming soon", Hardback available now)
by Jerome Groopman

It's worth a look, anyway, and probably available in a library near you (or, if not, it could become available if you request that they get it). If some of physician or other medical service person stumbles on this reference and checks it out, and decides to share what they think of it at some point, it would be appreciated.

One of the AMAZON reviews, the short one, is appended. Even if you decide the book is not for you, give the article and reviews a try. You probably won't regret it.


From Publishers Weekly
Reviewed 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 know Jerome 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.