Book Report: How Doctors Think

A book report on Peter Rabbit is the last time I’ve done one of these.

The name of the book about which
this book report is about is
How Doctors Think which is about this – doctor.

Described by the book jacket as a “window into the mind of the physician” and “myth-shattering”, our protagonist, Jerome Groopman, “explores the forces and thought processes behind the decision doctors make.” Which is exactly why I wanted to read this book. Because my father sees a lot of doctors to whom I like to ask a lot of questions and for which I get into a lot of trouble with both my father and mother because they think I shouldn’t be bothering the doctors.
Groopman’s got my back on that one though, as he not only encourages patients and their loved ones to question their doctors but gives you insight and suggested wording on the best way to get the doctor’s thinking along the right path about the case at hand.

He starts the book with a detailed case study of a woman who has been diagnosed with anorexia and irritable bowel syndrome by doctor after doctor. She was put on a 3,000 calorie diet consisting mostly of carbohydrates like cereal and pasta. But because she continued to lose weight, it was assumed by each doctor that she was lying when she told them she was following that diet to a T. After 15 years, she happened to see a specialist who ignored the mound of paperwork that came along with her and stopped to ask himself, “What would it mean if she wasn’t lying and really was still losing weight while consuming 3,000 calories a day?”
That was the key to his ultimate determination that she was actually allergic to gluten, a primary component of most grains. In short, for 15 years she had been ingesting a huge amount of the exact thing that was making her sick!

It is the use of this type of interesting, real-life case study that make How Doctors Thinkwell worth the read, together with Groopman’s council on how both patient and doctor are likely processing the information before them. Following is some of Groopman’s sage advice:

  • On average, physicians interrupt patients within eighteen seconds of when they begin telling their story. pg.17
  • The way a doctor asks a question structures the patient’s answers. Good doctors begin their conversations with general, open-ended questioning. Specific close-ended questioning – is the pain sharp or dull – suggests a doctor is attempting to pin down a diagnosis. If you are seeing a specialist, for example, or getting a second opinion, close-ended questioning at the beginning of your conversation suggests the doctor has been “tainted” by the write-ups from your other physicians and isn’t coming into the case open to catching a mis-diagnosis. pgs. 17-18
  • The sickest patients are least liked by doctors. Many doctors have deep feelings of failure when dealing with diseases that resist even the best therapy. This can lead to feelings of frustration and they may stop trying because all their hard work seems in vain. pg.19
  • Patients can learn to question and to think the way a doctor should. Questions like, “Doctor, what would be the worst thing that could be missed in my case?” pg. 23
  • Realize that you may fit a stereotype and let the doctor know you know so he knows not to become blinded by it. It will enhance your credibility. Take the case of an eccentric woman in her fifties complaining to the doctor of “feeling hot all over, which makes my skin crawl.” Most doctors would tell her it’s related to menopause and send her home (In fact, 5 out of 6 did just that. 2 told her she was crazy.) By finally addressing it, “Okay, I know menopausal women have hot flashes. But I think this is something else, something more than just menopause,” she helped doctor number six make a mental note of how easy it would be to make an attribution error in this woman’s case. The doctor was then able to stop herself and “assumed for a minute that her patient was telling her something important, something meaningful” that was “indeed different from run-of-the-mill menopause.” (Read the book to find out what was really wrong with her :) pgs.56-57
  • Force your doctor to generate a short list of alternatives, even if both you and he feel his diagnosis is spot on. Doing this is one of the strongest safeguards against cognitive errors. pg. 66
  • It is a fair question, especially in a fast paced ER, to ask, “Doctor, what’s the worst thing this can be?” By asking that question, a patient, friend, or family member can slow down the doctor’s pace and help him think more broadly. This is especially important during flu season, for example, where flu-like symptoms can too quickly be attributed to that which everyone else the doctors are seeing has. pg. 75
  • Another way that laypeople can focus a doctor’s attention is to ask: “What body parts are near where I am having my symptom?” This is especially important if you have a longstanding history with something in the same area, but you feel this is not the same kind of pain/feeling as it has been in the past. The woman in our case study from above might have said: “Yes, I know my irritable bowel syndrome is my chronic condition. But if the pain is something new, on top of that long-standing problem, what body part might be causing the symptom?” pg. 76

I’m only halfway through the book at this point, but I think there is enough here to give you a feel for how truly helpful and interesting a read this book is. I highly recommend this book for anyone who might ever find themselves sitting in a doctor’s office, so much so that you are welcome to borrow my copy. Read it. I think it’s a book you’ll enjoy, but make sure you return it because, like Robbie the Creep, I’ve got notes in the margin.

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