This Joy’s Life

Story Time for Jack from Joy Fisher on Vimeo.

If you call me an a**hole, I WILL put less than two feet between me and your bouncer.

I’m currently reading Outliers: The Story of Success by Malcom Gladwell, author of The Tipping Point: How Little Things Can Make a Big Difference and Blink: The Power of Thinking Without Thinking.  The entire book so far has been SUPER interesting, but there is one section in particular that I’ve loved for the insight it provides me as a Southerner.  Chad actually read it first and brought it to my attention because we constantly argue about the virtue of “the high road”.  I think there are times when taking the high road sends the message, “Sure, great, it’s fine to walk all over me.”  In those instances I prefer the middle to low road options and I’m not ashamed.  I’ve now gained some insight into this aspect of myself thanks to Chapter Six of Gladwell’s book and I have a name for it.  It’s due to my culture of honor and I’ll proudly “die like a man, like [my] brother did” when the time comes.  (Hey, don’t worry, Brett’s doing just fine.)

Here’s a link to the excerpt so you know what the heck I’m talking about.

My mother is now part of a secret society.  Well, no, it’s not really a secret, but what they do, I couldn’t tell you.  They claim to go out to lunch, a group of 50+ year old women wearing audacious red hats and purple clothing.  You may have heard of them, even seen them one afternoon while out to lunch yourself. They call themselves The Red Hat Society.

What do they discuss during these lunches? Besides lunch, what other types of gatherings do they attend? Do they have to memorize passwords like “The crow flies at dawn” or “The cow is in the cornfield?”  Where do they find all those red hats?  And don’t they know that red and purple don’t match?

These questions and more I can not get my mother to answer.  When asked who else is in her RHS group she vaugely responds “just some other women you don’t know.”  When asked what they are going to do that afternoon, another vauge response, “Oh, you know, the usual.”

By the looks of the above picture, the almost defensive stance, with her hand on her bag like she might, just might, be packing heat, I have to wonder what “the usual” really is.  Craft Stores around the country, be on notice! You may want to focus the cameras on those silk irises priced at 40% off.  With deals like that, your local RHS chapter may have you in their sights. I’m just saying.

Here’s hoping a mug shot of my mother on a Wanted poster doesn’t end up on the nightly news any time soon. If it should, mom, you know you can crash at our place in Seattle for a while, but they’ll come looking here for you soon enough. They always start with who you know.

“In Richard Thaler’s and Cass Sunstein’s book, Nudge, which uses urinals, ABBA, and Homer Simpson (and cutting-edge research) to argue that by simply giving more thought to the way they present choices to people — or “nudging” — choice architects can preserve freedom of choice while dramatically influencing the choices people make.”

That’s how one of my favorite blogs (and books) – Freakonomics introduces the book I’m currently reading, Nudge: Improving Decisions About Health, Wealth, and Happiness. Actually, I’ve been reading this book for a while and on the plane ride home I just happened to hit the chapter on Credit Markets. Now, this is government regulation that I can get behind! I’m going to provide an excerpt of the parts I thought were the most relevant to what’s happening in our economy right now, but first I want to give you a little more detail on one of the fundamental concepts of the book, that of Libertarian Paternalism.

The idea behind Libertarian Paternalism is that “we” want to change people’s behavior for their own good, not for our personal gain alone. That’s the paternalism piece. The other key aspect is that in doing so, we must not enact any rules, bans or laws. People must choose to make these changes of their own free will. That’s the Libertarian piece. Take smoking as an example. It is generally accepted that smoking is bad for you. Even smokers will agree with this. No one says, “Tomorrow, I’m going to start smoking.” But, you often hear people say, “Tomorrow, I’m going to quit smoking.” So, an appropriate nudge would be to help the person choose, of their own free will, to quit smoking as it is for their own benefit. The book delves deeper into this and other issues, but I want to focus on the Credit Markets chapter because it is so relevant right now in teaching us, in part, how we’ve found ourselves in this mess and what we might do to keep it from happening in the future:

When markets get more complicated, unsophisticated and uneducated shoppers will be especially disadvantaged by the complexity. . . These factors are exacerbated in the segment of the market that caters to the poorest and highest-risk borrowers, the so-called subprime market. . .

Some, particularly those left of center or in the news media, label all such loans with the derogatory term “predatory.” This broad brush fails to recognize the obvious fact that higher-risk loans will have to have higher risk interest rates to compensate the people who lend the money. The fact that poor and risky borrowers pay higher interest rates does NOT make these loans “predatory.” . . . On the other side, some observers think that the hue and cry about predatory lending is based entirely on the failure of left-leaning journalists and others to understand that risky loans require higher interest rates. As usual, the truth lies somewhere between the two extremes. Subprime lending is neither all good or all bad.

The good feature of subprime lending is that it offers credit to those who could not otherwise borrow, and makes it possible for some poor or high-risk families to become homeowners (or business owners). Subprime loans give people a valuable second chance. . . (134,135).

I’m going to stop here for a minute to backup and explain that one of the things Thaler & Sunstien have previously brought up in the book is how nudging can be used by the government. It is the simple idea of making complex consumer decisions more transparent. Take the cell phone market, for example. An appropriate nudge would be for the government to step in and regulate not how much carriers could charge for their services, but their disclosure practices. It would require carriers to make their fee schedules public in a standard spreadsheet type format and must include any and all fees the customer could be charged. Once a year, carriers would be required to send their customers a complete listing of all the ways they had used the phone and all the fees that had been incurred, thereby allowing the customer to easily see and compare their current plans with those of other carriers (93, 94). A real life example is the Truth In Lending Act which required credit companies to reveal a standard calculation of an annual percentage rate (APR) of interest to consumers. It then became quite easy to compare credit cards and make better decision about which one might be best for us (generally, the one with the lowest APR for the longest amount of time). Now that you understand that concept, I’ll continue with the excerpt:

In 2007 there was an eruption of subprime foreclosures, which caused ripples throughout financials markets, prompting many government bodies to think harder about how to help. Of course markets, left alone, will solve some of the problem, because investors who had been buying up subprime loans learned the hard way that the loans were riskier than they seemed. (In many ways, the mortgage brokers were deceiving the investors who bought up the loans as well as the people who borrowed the money.) But market forces did not prevent the problem from occurring, so there have been calls for more intervention. Some demand an end to predatory lending, but because loans do not come stamped “predatory,” it is hard to implement any such ban without depriving many deserving but high-risk borrowers from any source of financing. And of course, we libertarian paternalists do not favor bans. Instead, we prefer [to help] people make better choices and avoid loans that really are predatory – loans that exploit people’s ignorance, confusion, and vulnerability.

[We suggest changes to the Truth In Lending Act to make it relevant once again.] . . . Mortgage lenders would be required to report lending costs in two categories: fees and interest. . . research finds that people who get the best deals – by a lot! – are those who pay no fees (. . . the broker pays all the fees out of his commission. . .) The likely explanation for this result is that when the fee is zero, it is simpler for borrowers to compare terms, because the interest rate is the only thing they have to look at. The interest-rate disclosure would include the rate, of course, but also a schedule of payments over a period of years, assuming that the underlying interest rates do not change. This would ensure that borrowers at least know what their payments will be when the teaser rate ends. It would be a good idea to add some kind of worst-case scenario information so that borrowers can see how much their payments could go up in the future.

Lenders would also have to provide a detailed . . . report, that incorporates all the fees and interest rate provisions, including teaser rates, what the variable-rate changes are linked to, caps on the changes per year, and so forth. This information would allow independent third parties to offer much better advice. Our strong hunch is that if [this data] were made available, third-party services would emerge to compare lenders.

[This data] would thus make it much easier to shop for mortgages online, which would make the mortgage market more competitive. Online shopping is especially likely to help woman and minority groups. A study of automobile shopping found that women and African-Americans pay about the same amount as white males when they buy a car online, but at the dealership they pay more, even after you account for other factors, such as income (136-138).

I’ve been hearing and reading so many different opinions on our current economic situation in terms of what caused it, who was at fault, and what steps should be taken to keep it from happening again, that I thought this chapter was very interesting and written “in layman’s terms” to help me understand all the talk about predatory lending and subprime markets. If you had questions, as I do, here’s hoping you found this post helpful. Nudge: Improving Decisions About Health, Wealth, and Happiness is a super interesting read and I highly recommend it.

Both Sunstein and Thaler have made posts on the nudges blog specifically discussing the current economic situation if you are interested in reading them. If you are interested in reading a Q&A with the authors of Nudge, you can find one on the above mentioned Freakonomics blog here and on the Amazon.com website here (scroll down to the editorial reviews). You can also click here for a link to the Nudges website.

If Jenn hadn’t called to cancel on our girls night plans (her dad had just been released from the hospital, thank goodness, and she wanted to spend some time with him), I would have headed straight to her house around 4:45pm and not decided to head home and shower before meeting the girls in Tacoma for a fun night on the town. As it was, I was hot and sticky from the beautiful Seattle day and figured since it was just me trying to to meet up with the girls by 6pm, I’d give myself the extra time to get freshened up.

Clara was just waking from her nap at ten after five, when I got home – a full hour later than she should have been. I told Chad she would be up ’til 10 o’clock having slept that late! It was such a great day, I knew she could happily entertain herself if we set out the galvanized tub with an inch or two of water for her to play in. Getting her ready in her swim diaper and bathing “soup”, while Chad filled the tub on the deck, was cutting into my getting ready time. Once we got her out there, I had Chad take over so I could jump in the shower.

Afterwards, as I was putting on the finishing touches of makeup and jewelry, Clara came looking for me and that slowed down my progress significantly. If she hadn’t come into the bathroom wanting to play in mommy’s makeup, I probably would have been ready to head out the door by 5:45 or so. But it became quickly obvious that I was going to need a little more time. Then my cell phone rang, and it was Maria who was supposed to already be in Tacoma having dinner with her boyfriend, but he was running late and told her just to go ahead and meet up with the girls for our dinner. She was calling on the off chance that I hadn’t left the house yet (everyone knows I’m ALWAYS running late). Lucky for her (“we’ll see” said the Zen master) and me, I was still getting ready, so now we could carpool and save gas going the 30 miles south it would take to get us to dinner.

She arrived just before 6:30, we are both famished at this point, so we got on the road. I needed to get on I-5 South and as I was passing the on ramp to 509 South, which would have had us at least going in a southerly direction, Maria questioned if it wasn’t faster to go that way than the 509N to 518 to I-5 South I was planning to take. “Oh, yeah, if I’d thought it through, I probably would have gone that way. But it’s not too much out of the way to do the latter, which is now our only option. Whoops!”

Heading down I-5 South at a quarter to 7 on a Saturday night meant traffic wasn’t too tight and with us in the HOV lane, we had some room to maneuver. But, I wasn’t really in the mindset that I was going to need to as Maria and I discussed the painting she and Mike have been doing at their new house, her nervousness at chopping all her hair off into a great bob earlier that afternoon and the like. Perhaps if we hadn’t been talking, I would have noticed the black Lexus zooming up on us a second or two sooner than I did. As it was, I saw them at the last second. According to Maria I let out, “Is this a joke?” as the car that should have hit us at that moment seemed to back off. But, immediately it was speeding at us again and at the last second, as I was trying to move right into the fast lane, it was trying to swerve into the left shoulder. He didn’t quite make it and his front right hit our back left, putting us both into a tailspin, the moments of which will stay with me for the rest of my life.

It was so fast and yet playing in slow motion, the way were were being tousled back and forth, like one of those motion machine theaters you have to be a certain height for and to which “NO PREGNANT WOMEN [are] ALLOWED.” I had this feeling that pain was immanent while I waited for a car or pole to slam into us. I desperately tried to pump the brakes – was I pumping the brakes or the gas? I don’t know! – and kept my hands on the steering wheel. I could hear Maria screaming and felt as long as she was doing that, at least she was okay. Then we both thought the car was about to flip, but it didn’t and we stopped moving. You couldn’t see out the windows; dust was flying. I yelled at Maria, “Where are we? Maria, where are we?!” I was terrified that we had fully crossed the median and were now facing on-coming traffic on the other side of I-5.

Maria said she thought we were fine and in the median. I think we just sat there in shock and then I heard tires spinning out. If I hadn’t heard that, I would have missed the fact that the driver that hit us was attempting and did flee the scene! “Oh no he isn’t” was my thought and I yelled at Maria to “remember this number!” and rattled off the driver’s license plate over and over again. As I was trying to decide what to do next, I noticed a burning smell, similar to when the airbags go off after an accident.

That’s when I realized that the airbags hadn’t deployed and I was telling Maria, “We’ve got to get out! I think the car is on fire!” At that same moment I heard people yelling at us to “get of the car, it’s on fire!” The next thing I know, I’m standing outside the car, holding my little coach wallet in my hand and looking back to make sure Maria was right behind me. She wasn’t. She was still sitting the car. My next thought was what in the world am I going to cut her seat belt off with?? But, she was already out of her seat belt, she just couldn’t get her passenger side door open. I ran back to try to help her and had we both not been scared to death the car was going to blow any second, I’m sure we would have laughed even then at how ridiculous we must have looked with our hair “did”, in our going out clothes and heels, me trying to both run and drag her along the ground and she desperately trying salvage her purse, change her mind, climb over the parking brake, get around the steering wheel and get her footing on the hill!

After that, we were running down the shoulder. Maria kicked off her heels and I, at some point, dropped my purse. We were safe and the car was burning sky high within a minute or so. I don’t really know how long any of this took. There were so many people who stopped, offered us their cell phones, wanting to make sure we were alright and no one else was in the car. It was an amazing show of good samaritin-ness. I even remember that as I was trying to see the hit-and-run driver’s plates, a woman sped after him. I wan’t sure at the time she was following them for that reason, but it turns out that she was. And, thanks to her diligence, the police had caught the driver before the fire was even put out on our car. If she hadn’t followed him, he may still have been caught later, but he may not have, so I really appreciate the fact that she took the time to do that and, potentially, put herself in harms way for us.

That Maria and I were able to start half-joking about the fact that we literally walked away without any serious injuries as we were still watching the “flames, on the side of my face, breathing, breathless, heaving breaths” plume into the sky, is [circle the best answer: lucky, amazing, surreal, ludacris]. What if we hadn’t just walked away? What if we had spun into traffic? Had left a few minutes later or earlier? What if I’d taken the other route to I-5? If we’d been in Maria’s Civic instead of the Chad’s Maxima, if my daughter had been in the back seat, if either or both of us had been put into a coma or died? What if it happens again and the next time I’m not so lucky?

There are a thousands “what if’s” and I think I’ve played them all through my head since we sat down on the side of the road last night. I hope writing this all out will help me let it go. There is no use going down the what if path, except, I suppose, to help me find flaws and potential regrets in the way I have been and am living my life. I see that I need to get my will in order RIGHT NOW, that life is pretty simple in a lot of respects, and I need to continue the process I’ve already started to simplify mine so that I’m left with only time to play with my kid, enjoy my time with friends and family, and otherwise appreciate the things that matter in life.

I also see that I should be very thankful to play the “what if” game and not “if only.” If only Clara hadn’t been in the car. If only Maria was okay. If only the car hadn’t exploded. If only no one had died. If only it wasn’t my fault. That’s a game I never want to be forced to play.

So, a few years ago, I was seriously considering going back to school for a counseling degree with the goal of becoming a middle or high school counselor. I went through the application process for a couple of schools in the Seattle-area, but ultimately decided to turn down the acceptance offers for a number of reasons.

As part of the application process, I was required to write a personal statement discussing why I wanted to become a school counselor. Since this is my writing blog and I share some insight into my past life in that paper, I thought I’d post a few excerpts from it here for your reading pleasure(?):

With respect to grades, I was a very good student in school, but it was not until my senior year of high school that I finally began to understand what education was all about. Like most children, I was much more interested in the social scene than I was in studying for a pop quiz on the Vietnam War. In fact, if you were to ask me to tell you the one thing that stands out in my head about middle school, it wouldn’t be a good grade I made on some test, it would be the day my so-called friend, Johdi*, said to me, “So, where’d you get THAT dress?” rolling her eyes. I had gone shopping with my mom the day before and she let me pick out a few things for the new school year that I liked. For once, we both agreed that the dress in question – a fitted whitewashed jean number – looked great on me. But after Johdi’s suggestion that it might not actually be as “cool” as I thought, the dress didn’t see the outside of my closet until years later when it hit the bottom of the Goodwill bag.

In my professional life as a consultant, I have enjoyed being a teacher to my clients. However, in the five years I have sustained this role, I have not received that same personal satisfaction that I receive in just one session with Maria. I now seek to find a rewarding teacher-student type relationship beyond the conference room walls.

. . .

There you have it folks. That’s my personal statement that states things – personally.

*Name changed in case these friends should show up on Facebook and decide not to confirm my friend request after reading about themselves in these illuminating little antidotes. Friends, of any nature, are all that matter on Facebook y’all!

Does Clara’s Dora doll look a little bit evil to you right now?

Do you think I should be worried?

If you see an article like this in the news, go immediately to the police with this blog post:

Seattle Mom Tragically Slayed

A bizarre homicide has rocked the quiet Normandy Park neighborhood of Seattle-area resident Joy Fisher. There are no suspects at this time and the only info being released by the local authorities is that a Dora The Explorer doll with a rather large head, belonging to the deceased’s daughter, was found near the body. . .

Gwen says I have too much time on my hands.

I know now that I am a visual learner and I wish I had realized that back when I was a student in high school and even college.

When I was in high school, my senior year, I decided, rather randomly, that I wanted a letter jacket. But, to have a true letter jacket, I had to letter in some things. Because it actually is NOT cool to have a letter jacket with just one letter on it. Letter jacket is misleading; It’s really a letters jacket.

At the time when I made this decision, I was on track to letter in only one thing – Drama Club. Shocking, I know. Actually, I didn’t realize at the time that you could receive an academic letter, so I was already set with two. At any rate, I decided to attempt to letter in Track & Field. Mind you, I had never before in my life even stepped foot on a track. That’s the God’s honest truth.

So, anyway, the rule was that any senior on the track team would letter. And, pretty much, showing up for “tryouts” was the tryout. I was in!

It became quickly obvious that running wasn’t really my thing. (When I’m in shape, I can run til the cows come home, I just can’t do it very fast.) I was told that my track sports would be: hurdles, long jump and high jump. Not bad for never having done ANYTHING along these lines before.

I showed up the first day at hurdles, listened to the coach, and attempted to do as he asked. At the end of practice, he wanted to know what other events I was doing. Long jump and high jump. “Mmm,” he pondered, “that’s a lot on your plate. Maybe you should consider focusing on just the long jump and high jump.” Sure thing, coach.

Day two, I show up at the long jump, listened to the coach, and attempted to do as he asked. At the end of practice, he too wanted to know what other events I was doing. Just long jump and high jump. “Mmm,” he pondered, “You might do better to focus your efforts on just one event and get really good at it. Tomorrow give the high jump a try.” Uh oh.

Day three, I show up at the high jump. Lucky me! There is no coach for high jump so that’s my event. For about 15 minutes one of the coaches from the other events would come by and give us some pointers, otherwise I was just taking in advice from the other students who were also doing the high jump.

Then comes the first track meet and, to this day, I have no idea how I did it, but I won the meet for my event!! It was AWESOME. And the next morning, they called my name over the intercom along with the other track winners for our school. There was more than one surprised nod of approval and congratulations from my classmates. It was pretty great.

That was the apex of my track career. After that, things just went downhill. Our sometimes coach tried to give me pointers. He said that I was not arching my back enough and I really needed to kick my feet out at the last minute as I went over the pole. It was these two issues causing me to knock the pole over when I tried to increase the height. I practiced and tried. I thought I was doing what he said – arching my back and kicking out my feet – but I just never could quite get over the pole at any higher level.

Senior year ended and I lettered in track, as well as drama and beta club, so I had enough letters that I could hold my head high. And, I moved on from high school into college. My freshman year there, I lived in an apartment right behind the UGA track. My friends and I would meet there later in the evenings to workout once the blazing sun had gone down and our dinners had digested. We’d run the track, play a scrimmage game of soccer and otherwise goof around.

Mark Adams, a good friend and AMAZING photographer, was taking pictures of us on one such night. I was “practicing” my high jump for everyone’s enjoyment and he snapped this photo:

To this day, I’ve always wished that I could have seen this picture when I was still in high school, practicing at the track. It is so clear to me that my back needs to be arched and I should have kicked my feet out right at the moment he snapped this photo! I’ve cleared the pole by quite a bit. If only I had kicked out my feet!! I truly believe that having seen that while in high school, I could visualize it as I was flying backwards through the air at the next day’s practice and made the changes the sometimes coach suggested. I could have been a high jump contender!!

But, alas and anon, I will never know. This picture reminds me of that fact every time I see it.

This ad is by PricewaterhouseCoopers (PwC). Someone there is really in touch with the conflicting feelings a woman goes through when becoming a mother, except that I would say EVERY mother, not just those still working, experiences a similar struggle within themselves.

Now, a little over two years into motherhood, I’ve come to terms with who I may have let down by leaving the world of the working girl. I’m confident that work will be there in five to seven years once my child(ren) are in school and I find I have more time on my hands. In fact, I’ve been amazed at the opportunities for work that have fallen into my lap while I “sit” here at home with my daughter.

Still on the few occasions since becoming a mother where I’ve had to fill out any sort of application requesting my occupation and/or income, I am still finding it a struggle to write the word housewife. I grapple with the fact that “housewife” doesn’t seem to let the world know that I have a Bachelor’s degree. Which I worked hard for. Or that I worked as a systems auditing consultant for PwC and a software selection consultant for SoftResources or as a substitute teacher in the Highline District or with special ed children there as well. I’m diverse, man.

The term housewife severely downplays the fact that there is a serious amount of work involved, both mental and physical, in taking on occupation:housewife. It suggests that no income is necessary because it is not a job worth being compensated for monetarily when the child you are raising is your own. Will work for – free. Not even for food or a beer. (Hey, don’t get me wrong. I don’t need you to pay me to raise my own child, but I do want to establish the fact that it is work. Work that those in the business of childcare are getting paid upwards of $10-$20 an hour to do, so society does deem it “work” that has some monetary value in it.)

Housewife just has that old fashioned patina to it, being associated with tradition and the idea that “the woman’s place is in the home.” Although, in truth, I don’t think any of these are bad things. My mother was a stay at home mom and I’m so thankful that she was. I never looked down on her for it or thought that there was any reason she couldn’t have had her own successful career had she chosen to do so. It is because my parents raised me on the idea that I could be anything I wanted and there was no reason I couldn’t be out there working to pay the bills and buy a house and put food on the table, etc., that to choose not do so for a time, even if to raise my child, made me initially question my new found status as NON-contributor to society in the classic sense.

I don’t think woman who either must or choose to go back to work after having children have it much easier in the emotional struggle department, but sometimes, from where I sit (at home), the term working mother seems to connotate to the world that their is a woman whose got it together, who can both better herself and do for society, as well live in the traditional role of mother. Occupation:Working Mother suggests that this woman still has interests outside her child and that she’s not suddenly lost herself in poopy diapers and breastfeeding, not being able to converse about anything else. Housewife makes people wonder what in the world you do all day.

I guess the real question I should have asked myself goes back to the first word in the PwC ad – Who. Who, exactly, is “the world” that I worried so about misunderstanding me in that first year of motherhood? I think any other mother who chose to leave work for any amount of time probably realizes that housewife doesn’t begin to tell the whole story for any woman. I would say it also excludes the family, the husband and wife, who made the decision together that one partner should forgo an income to raise the children. Nor does it include any mother (or father) who does not have the luxury of forgoing their income. They may understand all the nuances of that term housewife better than anyone.

I guess the who are the me’s before motherhood, working women (and men) who’ve not crossed over into the world of raising children – yet. Now that I have become more comfortable in my role as “housewife”, I’m not sure why I felt so strongly the need to justify my decision to anyone. I suppose it was a lack of confidence in myself in the new role of mother and maybe not wanting to let go, entirely, of that old world of life before children when you are only really beholden to yourself.

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 Think well 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.