Non-fiction, medical. A well-written overview of medical biases in practice. Most of these are unconscious on the part of the doctor. Most can be corrected by a doctor’s studying his cases and the results of their diagnosis and treatment. The doctor must always be aware of the results of their treatment. The patient and their family and friends must also be aware of results and must be willing to keep asking questions. The successful treatment results from the active collaboration between doctors and their patients communicating freely, openly, and honestly. . ( )

Worth reading for insights to how doctors think and make decisions and how a patient can use this to advocate for themselves. But there are many anecdotes and some parts dragged. ( )

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 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. ( )

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 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. ( )

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. ( )

"There is nothing in biology or medicine so complicated that, if explained in clear and simple language, cannot be undtersood by any layperson. It's not quantum physics." Dr. Lina Lewis (this is a quote from the author Dr. Jerome Groopman's mentor, and that attitude pervades this book.
The book describes many different ways doctors achieve their best work- and more, it gives ways for patients to help them remember the best techniques they were taught (or may not have been taught) in med school and residency.
It covers some of the challenges posed by modern health care that can prevent doctors from doing what they came to medicine to do- to heal and help. If all patients read this, we'd have better perspective and be able to work with our doctors instead of at cross purposes, and better health would be the result. ( )

My first impression was to dismiss it as being anecdotal, but after finishing the book (because my father asked me to read it all) I have become newly sensitive to the role critical thinking must play in the choices we make about health care. ( )

This is a great book. It's easy to read, has lots of patient stories as examples, and offers a perspective most patients don't see. No matter your malady, if you want to be an empowered patient the author offers you a series of questions you MUST learn to ask your doctors. ( )

I picked this book up as a used book for 50 cents. Bought it just based on the cover title. It sat around my house for 2 months before I opened it to read the preface. Never put the book down. It was a quick read. Little technical jargon. If you liked the TV show "House" with the cranky genius doctor, you should enjoy this book. Its more about the psychology of decision making and what psychologists refer to as our cognitive errors rather then being about medicine. It over laps a lot with my reading on the same subject (cognitive errors) made by investors. These errors in thinking are part of the human brain. These apply to the highly intelligent every bit as much as they do to the average person. They apply to so called "experts" as well as non-experts. The best in their fields are aware of these errors and take measures to combat them. The book is a about Misdiagnosis not Medical Errors. Medical Errors are just systemic screw ups such as a hospital giving a drug to the wrong patient. (Actually, good progress is being made to eliminate these mistakes. For example, I walked into a hospital for an ultra sound and got one of those plastic wrist bracelets even though I was a fully conscious mobile outpatient. The bracelet was checked against the records and as well as I was asked my name and birthdate by the medical technicians.) Mis-diagnosis, is an error committed by the doctor when (s)he goes through the mental process to narrow down the patient's symptoms to a specific treatable disease and this process is where serious cognitive errors can arise. IF your diagnosis wrong, at best you will only continue to suffer, at worst, such as an incorrect cancer diagnosis, they can kill you!

One of my motivations for reading the book is, after years of swearing that I was NOT going to get back surgery, I am actually taking to surgeons. My condition is better defined then most "lower back pain" and its correction should NOT require the ever popular, often failed, spinal fusion. Interestingly, one chapter of the book does go into this huge industry of spinal fusions and largely confirms what I have read, i.e. that they usually fail to achieve symptom relief even when the operation is deemed to be a technical "success".

Other then the entertainment value, the book is intended to alert the patient (and friends and family) to be on the look out for signs your doctor may have erred in his diagnosis and offers you some tools to help your doctor get unstuck from a potentially incorrect initial diagnosis. The book explains that doctors are trained in formal "decision trees", yet no practicing doctors (after they finish their internship) uses them. Instead they use "pattern recognition". This especially is true for Emergency Room doctors which don't have the luxury of time. Questions like: "What else could it be?" or "What is the worst thing it could be?" are offered to get your doctor to go back to first principles and re-examine his "gut reaction" that he formed early during your first talk with him about the source of your current problem. ( )

Hear about this book on Stephen Colbert, when he interviewed the author. It's very interesting how he looks at doctors view of different cases. It starts looking at a patient who has had the same problem for 15 years and was misdiagnosed at the start. None of the following doctors seeing this patient ever questioned the first diagnosis. Basically shows that doctors are human too and they make mistakes. Don't be afraid to question them. ( )

There are doctors that follow the tune that the Medical Industrial Complex plays, and there are ones who buck the trend. Dr. Groopman is one of the latter, thankfully.

In How Doctors Think, The New Yorker staff writer and Harvard professor of medicine & researcher Dr. Groopman offers a distinctive look into the structure of Big Medica in search for what exactly is the type of mindset Doctors employ when practicing their jobs.

Groopman does a compelling job throughout the book in making sure he relates the plights plaguing medicine from both sides of the coin, from the patients perspective, as well as from the perspective of a physician. This aids in the book not being one sided. It helps greatly that he’s also a Doctor with experience in this very field.

From medical, money, marketing, uncertainty, dogma, to various other components of medicine, Groopman attempts to turn over as many stones as possible in his search for what issues are the ones plaguing Doctors the most.

A notable point in the book that hit close to home, which many people will relate to is the emotional tension that can arise at times between patients and their doctors. Essentially, whether patients and doctors like each other. Groopman relates what Social Psychologist, Judy Hall discovered regarding emotional tension:

“..that those feelings are hardly secret on either side of the table. In studies of primary care physicians and surgeons, patients knew remarkably accurately how the doctor actually felt about them. Much of this, of course, comes from nonverbal behavior: the physician’s facial expressions, how he is seated, whether his gestures are warm and welcoming or formal and remote. “The doctor is supposed to be emotionally neutral and evenhanded with everybody,” Hall said, “and we know that’s not true.”[1]

What’s worse, is that Hall’s research indicated:

“…that the sickest patients are the least liked by doctors, and that very sick people sense this disaffection. Overall, doctors tend to like healthier people more.”[2] So much for quality health care.

Along with the above example, the author additionally notes many other examples of issues that arise due to a crisis in communication which can arrive in myriad ways.

In fact, one of these issues that Groopman relates is that:

“…on average, physicians interrupt patients within eighteen seconds of when they begin telling their story.”[3]

Another salient aspect of Big Medica that the author sunk his teeth into was the psychological aspect of medicine. Predictably, far too often doctors/western medicine view the patients psychological components as being apart from the body, rather than taking a much-needed holistic approach.

Additionally, the institutional dogma that reigns down from the top is also touched upon in a few instances by the author. Open-mindedness is scoffed at, while conformity was expected.

Recounting an example of choosing between the availability of multiple medical options regarding a particular treatment, Groopman relates something noted by physician Jay Katz, who taught at Yale Law school at the time:

“In both [treatments]…we were educated for dogmatic certainty, for adopting one school of thought or the other, and for playing the game according to the venerable, but contradictory, rules that each institution sought to impose on staff, students and patients.”[4]

Another disturbing component that doctors acquiesce to that is covered by Groopman is how doctors far too often give into to corporate interests. This very issue has covered by other doctors such as Dr. Brogan, Dr. Breggin, Dr. Mercola and many others.

This book sheds much needed light into the inner workings of how doctors operate – how they think. While the author notes that a sizeable amount of the issues have a variety of roots at the outset, such as communication, what he conveys still leads to much concern within the Medical Industrial Complex.

In the end, individuals will need to become much more proactive/responsible in their health if they plan to breakaway from the conventional medical system that puts profits over people.

____________________________________________________________________________________

Sources & References:

[1] Dr. Jerome Groopman, M.D., How Doctors Think, pg. 19.
[2] Ibid., pg. 19
[3] Ibid., pg. 17
[4] Ibid., pg. 153 ( )

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. ( )

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

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. ( )

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 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. ( )

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. ( )

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 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.
( )

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. ( )

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, 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. ( )

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. ( )

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 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, veterinarians 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. ( )

This book was interesting for me, given that my dad's a hematologist, which is the specialty of the author of this book. I've learned throughout my life in grad school and dealing with doctors occasionally that everybody -- even so called "smart" people -- aren't always on the ball, and sometimes you have to be skeptical of an expert's opinion. This book pretty much lays that out.

HOWEVER, why is it that in the year 2007, the author can't seem to use a single female pronoun in the entire book when referring to a generic person? (Actually he does, once, at the end, to refer to a generic patient.) And then he has the gall to mention that female doctors don't get taken seriously. Well, if everybody writes books and articles referring to doctors as "he," it's no wonder that stereotype continues to this day. ( )

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 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 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. ( )

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 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. ( )

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 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. ( )