How Doctors Think

Everyone needs to be their own advocate for their health care. A good first step is to understand how doctors think, and that's what this book attempts to do. The book generally focuses on the problem of incorrect diagnoses. Following each example of incorrect diagnosis there is an analysis of the

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reasons why the errors were made. Then the authors suggests ways doctors and patients can avoid similar problems in the future. There are numerous ideas and suggestions for patients to use in improving their chances of being correctly diagnosed.

Generally speaking my reaction to most of the examples in the book was that the docors are human, and they can slip up occasionally. The book suggests that doctors are correct about 85% of the time. (Incidentally, that's about the same rate of accuracy as modern weather forecasting.) What I was most alarmed to learn about was how inaccurate radiologist and pathologists were. After hearing the accuracy rates for those professions, I think it to be unwise to allow a serious operation be performed based upon the test results reported by a single radiologist or pathologists.

The author is a doctor himself. One of the most interesting examples in the book was his own personal story of finding a solution for pain in his right hand. I lost count, but I think he visited about six different specialists trying to find a solution to the problem. I noticed that his wife, who's also a doctor, insisted on coming along to some of the visits with doctors to make sure her husband would ask the corrrect questions. He used his medical connections to get in to see what are considered to be the top experts in the nation, and even he was unhappy with the way he was treated. If he wasn't happy, imagine what happens to the rest of us. In the end he had a surgery done that gave him 80% full use of his hand, a bit short of perfection. However, if he had gone forward with about 4 of the 6 proposed operations, the result would have either been no improvement or maybe ending up in a worse condition.

The following is the review from my PageADay Book Lover's calendar:
Nobody’s perfect, not even your doctor. But most doctors get most diagnoses right most of the time. Jerome Groopman, Harvard Professor of Medicine and essayist for The New Yorker, examines those times when things go wrong. The questions Groopman asks are crucial: What assumptions do doctors make about patients that lead to misdiagnoses? And what can you, the patient, do to help your doctor think clearly and avoid fatal jumps to conclusions? This is one book that can definitely improve your health.

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Jerome Groopman explores different medical cases and analyzes the diagnostic process of doctors in different fields. He provides advice for patients on how to talk to doctors and what questions to ask to help the doctor's thought process. This was a very interesting and readable book, especially

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for anyone interested in medicine.

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This book is well-written and takes a good look at how doctors can unintentionally be harming their patients through cognitive errors. This is a very broad book, covering mostly adult internal medicine and radiology, with a little bit on the ICU and PICU. I'd like to see further books detailing

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cognitive errors of GPs, pediatricians, and OBs. However, if you are getting older or if you or someone you are close to is seriously ill, this is an excellent book to read to make sure that your doctor and you are on the same page when it comes to your care. I'd also liked to have seen more resources for patients.

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This book is written to try to explain how doctor's think for anyone who's ever been a patient. Groopman has thoroughly researched this topic, both by interviewing doctors and gathering as much relevant information on medical decision-making as he could. In short, he explains why doctor's make

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mistakes in diagnosis. It all comes down to being human.

In each chapter, Groopman describes an interesting case study in order to show a cognitive 'flaw' in diagnosis. I'll just list a few:

Doctors are taught to use Occam's razor, to find one answer whenever possible instead of two. But of course, sometimes a person really does have two conditions, lactose intolerance and irritable bowel syndrome, for instance, or Lyme disease complicating an old injury.

Doctors are taught to use statistics. If symptoms x, y, and z mean A 90% of the time, then they are taught to suspect A. In reality of course, 10% of their patients will have B, but it's hard to break out of the odds and insurance companies of course insist upon probabilistic methods.

Human beings are influenced by recent experience. If a doctor made a mistake in diagnosis once, he is much more likely to look for that combination of symptoms again, possibly over-compensating.

The power of positivity: if a test show something wrong (a mass on the MRI/ bad blood chemistry), a doctor may attribute the current symptoms to that condition, even though they could be unrelated.

No single doctor can know all existing medical knowledge. Thus, specialists view problems in terms of their specialty and generalists have less depth in any one field. Especially for obscure conditions, this can make diagnosis difficult.

Groopman goes on at great length, but the list is actually quite an interesting attempt to explain how people, not just doctors, deduce things. Many of the flaws Groopman points out are unavoidable. If there is a flaw in the book itself, it is that he is too little an apologist. That is, he seems to think doctors can learn to avoid these mistakes (true to some extent) and that if you just keep looking long enough you'll find a doctor who can give you the right diagnosis to your problem. Doesn't anyone remember anymore that we don't actually have an explanation for everything? If we did, we could pack up and go home. They could just reissue the same edition of all medical texts year after year. No, we are still learning, so even the best doctor, even the best collection of doctors, may not have an answer.

What Groopman does well is give the patient power to be part of the decision, to ask his doctor to think outside the box, to know no one is infallible, to participate. All in all, this was an interesting book, well-researched and with some very good observations.

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This was a nice counterpoint to October's medical read, Better. Both take on the subject of how doctors interact with patients, and how they can learn to give better care. While I think Gawande is a stronger writer, this book is well-written and insightful. If you care about the subject, read both.

This is a great book, but a little too long in places. Groopman goes through common cognitive errors and shows how doctors make them. He tells a story for each one. There is quite a lot of this. He also takes a few potshots at evidence based medicine along the way.

Sometimes I found myself

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wondering who the intended audience was. There was alot of advice for doctors about how to be better doctors, but there only seemed to be a smear of information about how to be a better patient and get better results from doctors. Overall, it was a good read and good information to know.

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I appreciate the self reflection of the authors. His description of the potential for misdiagnosis and reasons for it are logical and revealing. It is reasonable that a surgeon must inflict pain to their patient to potentially solve a condition. This requires somewhat of a egotistical outlook. I

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liked the book because the author is truthful. After a while the theme becomes repetitive and you just get more examples from different fields of medicine, but I would recommend the book.

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As a premed student and father of a son who has had some medical issues, I found this book to be an excellent peak into the slippery parts of medicine. Especially the chapter about the woman who's newly adopted child was being misdiagnosed. She did her own research and had the courage to keep

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pestering her doctor about some ideas she had about the disease. I have always heard that doctors don't like being told by their patients what to do, but it can be the patients' responsibility to do some research. The book explains how doctors are pounded in medical school that if it sounds like a horse and looks like a horse, it's a horse (and not a zebra).

Dr. Groopman does a fine job explaining the issue of challenging your doctor. Although doctors (rightly so in most cases) will look at the simplest answer (one cause instead of several, or an American disease rather than something foreign) this can only work the majority of the time. In rare cases he or she will be wrong, and a concerned patient can think without the same boxes the doctor might be thinking in.

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Dr. Groopman helps us all become better advocates for our own health care by describing some case studies and what the doctors did well (or not so well) in diagnosing and treating their patients. I've been reading this book off and on over the past few months - it's easy to come back to if you've

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put it down for awhile. It's interesting but not overly technical; it's heartwarming at parts but scary in others. Some chapters are a little long but easily skimmable if a particular story isn't your favorite.

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This was an excellent book for what it was, but it certainly doesn't contain the excitement or excellent writing that would warrant a much higher rating.The title explains this book perfectly, as Groopman shows us that doctors are subject to the same cognitive errors as everyone else. He outlines

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cognitive traps like availability error and confirmation bias, explains how doctors fall prey to them during diagnosis, and then provides us patients with techniques for helping doctors steer around these.Most useful is this last aspect of Groopman's book - that is, giving patients tools to deal with the mistakes in thinking that doctors will inevitably make.Groopman, though, should be applauded for his balanced approach here. Having recently read "Better" by Atul Gawande, Groopman's perspective is refreshingly aware of subtlety. In almost direct opposition to Gawande's simplistic and misguided conclusions, Groopman doesn't feel the need to come to any specific conclusions at all. The issue of improving care, which both books treat, is clearly a complicated one that cannot fit simple conclusions. Gawande, frighteningly, tries to do so and come up with a silly notion that a *less* human form of doctoring should prevail, with tests and objective scoring sheets trumping doctors' intuition. Groopman, on the other hand, asserts that there is no way to a good diagnosis without people who are thinking clearly about patients as individuals.In the end, I think everyone should be aware of what this book has to say, especially considering the practical advice he gives to patients. However, don't expect to be bowled over by beautiful story-telling or unrelenting suspense.

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Poses though-provoking questions on decision making and paradigms in the medical profession.

Everybody who wants to be an informed patient should read this book. As always, Groopman writes lucidly, economically and engagingly about the cognitive errors we all fall into--and why they may be especially relevant--and dangerous--in doctors' thinking. Fascinating.

Like being inside Dr. House's head - well, if he also had a bedside manner. Oh, and admitted mistakes. Also, blessed with humility. If there's a double, overarching takeaway from this book, it's to a) speak your mind and voice your concerns, b) get a second opinion.

Or, how new residents, internists, radiologists, surgeons, general practitioners, pediatricians, etc, make decisions including wrong decisions, in life and death situations. The early anecdote of the author being alone in a ward, with nothing but a stack of 3X5 cards, is chilling. It just shows how

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amazingly brave one has to be, to simply be a doctor.

The book goes on and on with complicated case descriptions that show potential decision errors in bias, influence of training, and even drug and medical product marketing.

I'm sure concepts described here could be carried over to Chemical Safety Board and FAA investigators, auto mechanics, vetinarians and many different trades. Stay with this one. It is long and technical, but you will learn a great deal of interesting medicine along the way.

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Book on CD read by Michael Prichard
3***

Groopman did a wealth of research and extensive interviews with some of America’s best doctors, as well as used his own experiences as a physician and as a patient, to craft this treatise on the thought processes behind the decisions made by physicians. He

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expounds on the cognitive pitfalls that might cause misguided care: premature closure, framing effect, search satisfaction. He also explores the tendency to rely on algorithms and statistical profiles rather than on the changes and nuances of a particular patient’s illness.

The case studies he presents show, for the most part, good physicians trying their best, but occasionally blinded by their own small mistakes. For example, if your doctor writes an order to “rule out pulmonary embolism” the radiologist reading your studies might look ONLY for that possible diagnosis, and miss the real cause of your symptoms. Or a physician relying on credible studies that confirm that treatment A is the best treatment for patients in a certain phase of a cancer might fail to take into account the particular presentation of the disease in this patient and be reluctant to try a treatment that is NOT on the “recommended” list.

Groopman’s primary conclusion is that the patient can and should be a partner in the care given/received. Patients can help their physicians think more broadly by asking some basic questions: What else could it be? Is there anything that doesn’t fit this diagnosis? Is it possible I have more than one problem?

Prichard does an adequate job reading the audio book. His voice has a certain droning quality, however, which did nothing to make this sound interesting. I enjoy medical literature, so this didn’t deter me, but I did read a few of the chapters rather than listen to Prichard’s somewhat boring recitation.

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This is worth a read. You're likely to move through it fairly quickly. The book does provide some things to think on when in need of medical help. Asking questions is a very good thing and Groopman does well to essentially target what to consider. Example, when being told a list of potential side

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effects to a drug or possible negative outcomes to a procedure, ask why the probability or likelihood is for each. Seems obvious and simple, but I know I've never do this. Also, recognize that most doctors are trained in a specific manner, using Bayesian logic, similar to what computers use to stop SPAM from reaching you. It's the application of logic trees using yes/no responses and -while respected- it not perfect. Actually, this is another key Groopman point. Doctors are not perfect -even the highly specialized docs.

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Scary, but fascinating. It reinforces my experience that the most confidence-inspiring physicians are those who are willing to say, "I don't know" when they don't, rather than, "Oh sure, I've got that covered," when really they're clueless.

Scary, but fascinating. It reinforces my experience that the most confidence-inspiring physicians are those who are willing to say, "I don't know" when they don't, rather than, "Oh sure, I've got that covered," when really they're clueless.

An insightful look into the things that happen to make hard cases successful or devastating.

Valuable to folks who want to be an active participant in managing their health. Easy to read and also thorough - more than a pop self-help book.

Great for those of us who have to deal with doctors on a regular basis and need to stay informed to get the best care possible.

I'll be interested in seeing how Watson the computer does as a doctor.

While this book uniformly receives "5's" my curmudgeonly side gives it a "4." The book was overall excellent but some parts dragged from a bit too much detail. But it is worth the read.

The main premise was defective communication by doctors. The minor premise though was equally scary; the number of

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botched diagnoses but top doctors at top hospitals. On the other hand I recognize that sick people are inherently damaged goods. Perfection is impossible since medicine is an art, not a science.

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It makes perfect sense when you reflect on it, but Groopman's description of the Bayesian indoctrination of doctor training provides a lot of insight into the common conflicts or deficits of medical interaction. The takeaways aren't simplistic so much as simply reinforcing that patients and peers

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should remember that doctors are human. Cognitive errors are common, no matter how elite and trained a professional is. Patient advocacy and a deeper engagement with a specialist's rationale is not easy to appreciate or apply until you realize just how often common medical conventions prevent them from even being considered.

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I think much of the advice for patients could be explained in a 5 page article.. but if you want to read about the case studies then this book will interest you I think. I definitely feel like I'll be a better patient now.. in the sense that I know what I should tell the doctor about my symptoms,

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etc.. and will have a better feeling about when I need to change doctors or ask the doctor to take a look at this from a different angle. Good but not mindblowing book.

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