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| How Doctors Think | 
 enlarge | Author: Jerome Groopman
Publisher: Mariner Books
Category: Book
List Price: $15.95
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Avg. Customer Rating:  153 reviews
Sales Rank: 505
Media: Paperback
Edition: 1
Number Of Items: 1
Pages: 336
Shipping Weight (lbs): 0.8
Dimensions (in): 8.2 x 5.4 x 1
ISBN: 0547053649
Dewey Decimal Number: 610
EAN: 9780547053646
ASIN: 0547053649
Publication Date: March 12, 2008
Availability: Usually ships in 1-2 business days
Condition: Softcover. Cover corners have light wear. Slight cover wear. Pages appear unmarked. Ships the next business day, with tracking and delivery confirmation sent to your email.
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Product Description
How Doctors Think is a window into the mind of the physician and an insightful examination of the all-important relationship between doctors and their patients. In this myth-shattering work, Jerome Groopman explores the forces and thought processes behind the decisions doctors make. He pinpints why doctors succeed and why they err. Most important, Groopman shows when and how doctors can -- with our help -- avoid snap judgments, embrace uncertainty, communicate effectively, and deploy other skills that can profoundly impact our health.
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| Customer Reviews: Read 148 more reviews...
 Groopman uses irrelevant anecdotes to support a misleading conclusion April 22, 2007
159 out of 201 found this review helpful
How Doctors Think, by Jerome Groopman, is enjoying near-unanimous praise. Unfortunately, as was the case with Malcolm Gladwell's awesomely over-hyped books The Tipping Point and Blink, the praise is itself enormously misleading as it comes from an audience unqualified to assess the scientific basis of the claims being made by the author.
What Groopman has done in How Doctors Think is compiled a series of lengthy anecdotes about doctors he knows and some extraordinary, atypical diagnostic misadventures they've encountered. He states over and over again that many medical diagnoses are wrong (about 15% actually), and also states over and over that the reason why so many medical diagnoses are wrong has nothing to do with "misdiagnosis" proper, but rather with the heuristics that physicians rely on to make decisions in the quick and dirty real world.
These heuristics, or, mental "short cuts," are essentially snap judgments made on imprecise rules garnered from experience. They are often accurate, but are subject to a breadth of biases that can lead one to irrational and inaccurate conclusions. Now, before I state what follows, let me preface it by stating that I am a decision-science researcher, which is the field Groopman is actually referring to indirectly throughout his entire book. I have also worked in the field of medical decision making, and so am intimately familiar with the field Groopman is here presenting himself as an authority on.
With that preface out of the way, let it be said that what Groopman is doing in his book is both misleading and somewhat disingenuous. He wants us to know that doctors' thinking is clouded by heuristics and biased snap judgments, and yet, throughout the entire book, he BASHES evidence-based medicine, diagnostic decision aids, the use of algorithms, and Bayesian reasoning! In short, he picks up on what decision-science researchers say is WRONG with doctors and medicine, but then rejects what the same science suggests is the best way to remedy the problem!!
What does Groopman tout in place of evidence-based medicine? Why, good old clinical intuition--asking open-ended questions, listening, reading "body language," etc.; in short, the exact very same things that lead to the inaccuracy of doctors' diagnoses in the first place. The main problem with Groopman's book is his sloppy methodology. He insists that evidence-based medicine actually decreases the accuracy of real-world diagnoses, and yet, to back such an outlandish claim, he falls back on nothing but anecdotes describing rare and unrepresentative instances.
For instance, actual research in this area (by Corey and Merenstein) has demonstrated that an acute ischemic heart disease predictive instrument reduced false positive rates from 71% to 0. This is extraordinarily impressive, and would dramatically increase the diagnostic accuracy of physicians using it. Following the demonstration of the aid's effectiveness, how many physicians actually went on to use it? 2.8%!! Why? Because doctors like to think that their "deep clinical insight" is more accurate than actuarial (statistical) diagnosis. It's not.
Actuarial diagnosis guarantees that the same input will result in the same diagnosis. This maximizes accuracy. Studies show that actuarial diagnostic procedures made off of doctors' performances are even more accurate than the very doctors they are based on. Why? Because doctors' diagnoses are idiosyncratic and inconsistent. They treat every case as though it is "unique" (which only actually increases errors) while demanding ignorantly that "group statistics don't apply to individual cases."
This lunacy is obviously false. After all, if it were true, science simply wouldn't work, ever, at all. If Groopman had spent half the time he spent gathering irrelevant interviews reading some actual research in this area, his book would have greatly benefited. As an insider, as a scientist who actually conducts research on the very topics Groopman discusses throughout his book, my unfortunate conclusion is that the whole book is a complete waste of time. He spends hundreds of pages touting how important it is for us patients to know how doctors think. How much time does he spend actually discussing the biases that taint doctors' thinking? A few pages.
Further--and this is a point that seems entirely lost on Groopman--the heuristics that bias doctors' thinking regarding diagnosis will also bias their thinking about their thinking! That is why, if you really want to learn "how doctors think," you will have to do more than simply ask them. That is also why I have suggested this book be renamed "How Doctors Think They Think." In a brilliant observation made in a blog (The Last Psychiatrist) this book was described as being nothing more than "porn for doctors." I agree.
 "As many as 15 percent of all diagnoses are inaccurate...a distressingly high rate of misdiagnosis." March 24, 2007
115 out of 128 found this review helpful
This alarming statistic introduces Dr. Jerome Groopman's compelling analysis of how doctors think--and what this means for patients seeking diagnoses. Groopman is curious to discover how one doctor misses a diagnosis which another doctor gets. Interviewing specialists in different fields, he analyzes the ways they approach patients, how they gather information, how much they may credit or discredit the previous medical histories and diagnoses of these patients, how they deal with symptoms which may not fit a particular diagnosis, and how they arrive at a final diagnosis.
Throughout, he considers the doctors' time constraints, the pressures on them to see a certain number of patients each day, the limitations on tests which are imposed by insurance companies or by hospitals themselves, and the many options for treating a single disease. He is sympathetic, both toward the patient and the physician, and, because he himself has had medical problems, he provides insights from his own experience to show how physicians (and patients) think.
Case histories abound, beginning with the 82-pound woman, whose celiac disease was not diagnosed for fifteen years. Here Groopman analyzes the uses and misuses of clinical decision trees and algorithms used by many doctors and hospitals to assess probabilities and make decision-making more efficient. Sometimes, however, it is necessary for a doctor to depart from the algorithm and obey intuition. Recognizing when the physician is "winging it"--depending too much on intuition and too little on evidence--is a challenge for both patients and other physicians. Ultimately, Groopman focuses on language as the key to diagnosis, showing that when patients and physicians can communicate and truly share information, they have a better chance to come to correct diagnoses and appropriate treatments.
The success of Groopman's book attests to the need for discussion of these issues, but I am not sure Groopman realizes the difficulty patients have in finding ideal doctors whose personalities, thinking, and communication styles are compatible with their own. Most of us are referred to specialists by our primary care physicians (some of whom we see only once a year and do not know well), and it is not possible to interview several specialists to find the one most compatible. We accept the appointment our primary care physician has set up for us, often with the specialist who has the earliest available appointment. Patients with urgent problems may have fewer choices than Groopman seems to think they have. Though we all search for the ideal, ultimately we must hope that our own diagnoses are not among the "problem fifteen percent." (4.5 stars) n Mary Whipple
The Patient: Leader of the Healthcare Team April 1, 2007
73 out of 88 found this review helpful
"Patients and their loved ones swim together with physicians in a sea of feelings. Each needs to keep an eye on a neutral shore where flags are planted to warn of perilous emotional currents". Jerome Groopman
The Patient: as an undergrad in college in my nursing program, I was educated to understand that I always needed to listen to my patient, really listen. That philosophy has always served me well. Health care providers tend to be controlling, and when we, the patients, are given a diagnosis that shakes us to our core we need some control. As patients we need a physician and health care team that has the patient as the leader of the team. We listen to all of the recommendations and weigh the evidence as best we can. In the end we need to be able to trust our physicians and have a relationship that allows humor and sadness, questions and answers and honest give and take. It is a relationship like no other- it is sometimes life and death.
Jerome Groopman has written a book for everyone. Everyone needs to be their own advocate for their healthcare. His ideas that the way physicians think result in the treatment and care for each and every one of us. "Every doctor makes mistakes in diagnosis and treatment," he writes. "But the frequency of those mistakes, and their severity, can be reduced by understanding how a doctor thinks and how he or she can think better." He discusses the physicians who 'read' x-rays and CT's and MRI's, the radiologist. An exacting science is needed here. A radiologist with experience can pick up a disease process by the thickness of a rib. There is an accepted 'error' ratio in this science, and none of us want to be in that error ratio. There is a computer program to assist in diagnosis, but it is not perfect. We all want and need the experienced radiologist. When I entered the world of health care I learned that medicine is 50% rule out or question of. It remains in that corner. That is how we want our physicins to think-rule out #1,2,3 and come to a conclusion based on science, best practice and their ability to put it all together for us, the individual.
He helps the layperson understand doctors' thinking with simple and accessible terms that suggest why it sometimes leads to undesired outcomes. As David Kessler in his reviews states "He introduces us to terms such as "diagnosis momentum" -- when a diagnosis becomes fixed in the mind of the physician despite incomplete evidence. Or "availability," which means the tendency to judge the likelihood of a medical event by the ease with which relevant examples come to mind. He takes phrases patients often hear, such as "we see this sometimes" and puts forth the idea that such generic comments deserve further questioning from the patients."
Dr Groopman has written of fascinating case studies and the physicians who were part of them. The errors and the asute diagnoses are compiled in story after story. Physicians are open about the way and the analytical methods they use in deliniating the final diagnosis. It is difficult to forget the misfortunes of some patients. We understand a little more completely the real-life drama that physicians face in their mistakes and when their diagnosis is right on.
We learn about Bayesian Perspective thinking. "We all like to know how reliable and how risky certain situations are, and our increasing reliance on technology has led to the need for more precise assessments than ever before. Such precision has resulted in efforts both to sharpen the notions of risk and reliability, and to quantify them. Quantification is required for normative decision-making, especially decisions pertaining to our safety and well being. Increasingly in recent years Bayesian methods have become key to such quantifications." says Dr Groopman. The thought processes of physicians is an insight few of us have thought about. We should all be prepared for our next encounter.
It was refreshing to learn of Dr Groopman's frustrations with his medical care, and the four different opinions he received about his right hand. He carefully delineates how each physician came to their conclusion, and this is the type of thinking we need to engage in. We all have our stories of healthcare, and this book will give us more insight into the 'whys and wherefores' of our physicians' thought processes.
"Dr. Groopman gives a brief mention of how modern evidence-based medicine competes with the art of using your intuition. He touches on how drug and insurance companies pressure doctors as he explores their influence via big drug company sales representatives. I would have liked him to have written more about the influence of insurance companies, an area barely touched on, and about finances. This might have given readers a more complete picture of the intersection of medicine and finances." David Kessler
Most of us will be left with more respect for the art of medicine, and the careful consideration Groopman's doctors give to their patients. "How Doctors Think" is a book every patient needs to read. We, the patients have much more power than we know, and we can change the shape of the physician/patient relationship. We need to come to the doctor's office prepared to ask the right questions so that our physician's thought processes will be beneficial to both of us.
Highly Recommended. prisrob 4-01-07
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"Groupman" April 1, 2007
54 out of 106 found this review helpful
Dr. Groopman's assertion that he can disect the thought process of physycians and neatly package them into preformed packages is absurd. As a physician, I rarely see two physicians that approach a problem using the same method. Are there doctors that jump at the first convenient diagnosis? Absolutely, however for each one of them there are multiple deliberative thoughtful physicians. Dr.Groopman arguments degenerate into anecdotal story telling. He cherry picks a few choice stories to entice and capture his audience. He reports the superficial and ignores the more complex process that goes on below. Dr. Groopman has been isolated in his ivory tower too long.
Practcal matters bolster Dr.Groopman's arguments. Hospitals, insurance companies demand a diagnosis to admit and pay for hospital stays and evaluations. We are often in the position of making a best guess to get the patient in the proper environment to allow efficient evaluation and arrive at the proper diagnosis. Unfortunately, not every diagnosis is immediately evident, though Dr. Groopman must surely possess an omniscience that most of the rest of us lack. We actually have to work toward a diagnosis.
Dr. Groopman's book is little more than a gossip rag. I'll be the first to admit that physicians aren't perfect. I'll be the last to claim I understand the common thread by which they think. I'll also be the last to paint the entire prfession with a broad brush.
Dr. Groopman makes great fodder for the Stephen Colbert, Jon Stewart, Today Show circuits. I have watched him interviewed several times and he can never delve deeper the anecdote.
Congratulations to Dr. Groopman for his financial windfall. Shame on him for trying to stain a profession for self gain. He hasn't helped anyone with this book. He continues to feed the conspiracy that physicians are more interested in their egos than in helping patients. In reality nothing is further from the truth.
Doctors ARENT flawless March 25, 2007
48 out of 65 found this review helpful
This book should be considered the true successor to "Our bodies, Ourselves". That 1970's feminist health classic had encouraged women to proactively learn about and understand both their bodies and the politics of the American health care system, arguing that 'patients' had a right to actively participate in their own care rather than remain subjects who passively have procedures performed on them by ' the experts'.
Well, it's a good thing too because the experts (for a multitude of reasons) can err in their judgments according to the thesis of Groopman's book. In the 21st century, we like to think of our self as sophisticated. However Americans still cling to a cultural perception of the doctor as a superhero-magician who can and will cure everything effortlessly.
His powerfully researched book with first-hand interviews from doctors themselves dispels myths whether it is limitations of the ever-burdened medical system, their own human nature, or the ever-despised insurance companies who only see profit as the bottom line and don't care about human life.
Trying to maintain clinical neutrality is a next to impossible goal. Doctors favor some patients over others--circumstances which again produces surprising results. I was prepared to believe that the patients who were favored would receive the five-star treatment, but they were the ones who the doctors did not believe needed urgent care when a more serious problem was lurking. However, it is not surprising that if you even suspect that your doctor does not like you, its time to get a new doctor--STAT!
Considering that medical options are developing allegedly to help people cure symptoms and other people 'get better'--to say nothing of faster or easier, I find it interesting that they are among the culprits also named in this book, doctors honestly are bewildered by all of the treatment options now confronting them in sharp contrast to their predecessors. Technological advances aren't always a blessing if the gatekeepers then they have a case of information overload.
Reading this book after switching neurologists gave me a fresh perspective on my past experiences. I no longer think of that previous doctor as having been a bad person, but somebody who had not wanted to believe that something he had prescribed for me was hurting me simply because I was a woman and the medicine yes, did have gender-specific side effects which had not been documented during the FDA's original approval process simply because the agency did not then require testing of medicine for the general population on women.
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