How Doctors Think; a book review

I have just finished reading Dr. Jerome Groopman's book, titled, "How Doctors Think," (2007, Houghton Mifflin).

I was dissapointed with the book, which started well, but turned into a parade of name dropping anecdotes by Dr. Groopman, such as, "We met some thirty years ago when she was a student and I was a resident," (referring to Dr. JudyAnn Bigby, now Secretary of Health and Human Services in Massachusetts). Apart from the possibility that Dr. Bigby might not appreciate the apparent age disclosure, his inclusion of her story was really about how she sees the practice of medicine today, supported by a couple of anecdotes.

The slip cover offers this tantalising promise, "How Doctors think offers, direct, intelligent questions patients can ask their doctors to help them get back on track." Personally, I did not agree that it delivered these questions to help patients. If the emphasis was meant to be on, "intelligent," rather than, "patients," (who tend to be average, because the law of large numbers applies to them), then his promise is open to interpretation, and is possibly misleading.

He included a chapter entitled, "Epilogue: A patient's questions," (why as an epilogue? I thought this book was to provide advice to patients!). In it he offers patients this advice, "If, after a while, you are not getting better, the discomfort persists or has worsened, then it is time to rethink the diagnosis." Interesting advice, eh?

He goes on, "How to make the correct diagnosis? There is no single script that every doctor or patient should follow," (Since when did patients start making diagnoses?). He then offers this insight, "So a thinking doctor returns to language..." (remember, this is the only chapter dedicated to the patient!), and proceeds to imply that misdiagnoses are really caused by patients not properly including all the clinical clues doctors need, when originally describing their symptoms. That was a lot of sour medicine for the critical patient to swallow in one go!

Dr. Groopman dealt with a number of contentious and contemporary issues, particularly around the problem of medical error, and his general thesis was that errors occur, and the way doctors approach patient care has a significant impact on the outcome. (Now that was a surprise!). He claims that doctors follow specific patterns because they were trained to do so by their instructors, and that some of these approaches have no scientific bases. (Not very comforting news to patients!) Whilst he dealt with a number of issues, he relied heavily on a limited number of sources, and I was surprised that there was such limited evidence.

He contends that medicine is an uncertain science and advised patients to challenge doctors' diagnosis, particularly if those patients are regarded as cranks. He failed to deal with how to ascertain that professionally, and still keep a relationship with your medical provider. In fact, he suggests, (at the end of his 26 page introduction), that patients who are not getting a straight answer should, "freely broach the issue with their doctor, 'I sense that we may not be communicating well,' a patient can say. This signals the physician that there is a problem in compatability." Does this sound like a typical patient:doctor exchange to you? Me neither.

I felt that this was more a book for medical professionals in mid career, than a book for patients. In fact I felt that it was a, "filler," book which took advantage of the interest in patient informatics. I suspect that Dr. Groopman, (whom I don't know), is an intelligent and articulate man who decided to follow a pet project, but, on this occasion at least, failed to contribute much to the understanding of patient:doctor relationships.

As a health literacy proponent, I felt that the writing style adopted, (although possibly appropriate for the New Yorker, where the author is a regular contributor), was completely inappropriate for an average patient in the US, (on whom many literacy studies exist, and whose range of reading skills are well known).

So, I would recommend this book to; people who work at Beth Israel Deaconess Hospital in Boston, Mass. USA, and want to get promoted; to mid career medical professionals who wonder why their patients seem so cranky these days; to literary buffs who want to know how to write for the New Yorker; to socialites in Boston who want stories about medical practitioners, and pretty much no one else.

If it is not clear by now, I did not enjoy this book, and did not think that it added anything to the body of important work in understanding medical cognition such as that by Patel et al., (1). Sorry for the sarcasm in this review, but some of the contents deserved it.

I have to be fair, and say that the book has been on the New York Times hardcover nonfiction best seller list for 4 weeks, (rising to number 4), and that my review is distinctly different to the New York Times literary reviews by William Grimes, (2), and Michael Crichton, (3), who commended it.

Stay healthy, and read good books that can help patients,

Foster

1. Patel, V. L., J. F. Arocha, et al. (2001). "A primer on aspects of cognition for medical informatics." J Am Med Inform Assoc 8(4): 324-43.

2. http://www.nytimes.com/2007/03/23/books/23book.html?ex=1176696000&en=25aa21b2e8452099&ei=5070 accessed April 14, 2007 (registration required).

3. http://www.nytimes.com/2007/04/01/books/review/Crichton.t.html?pagewanted=1&ei=5070&en=d63b39649668eb0c&ex=1176696000 accessed April 14, 2007 (registration required).