How Doctors Think | 
 enlarge | Author: Jerome Groopman
Publisher: Houghton Mifflin Company
Category: Book
List Price: $26.00
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Avg. Customer Rating:  158 reviews
Sales Rank: 12928
Media: Hardcover
Edition: 1
Number Of Items: 1
Pages: 320
Shipping Weight (lbs): 1.2
Dimensions (in): 9.1 x 6.1 x 1.1
ISBN: 0618610030
Dewey Decimal Number: 610
EAN: 9780618610037
ASIN: 0618610030
Publication Date: March 19, 2007
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Product Description
On average, a physician will interrupt a patient describing her symptoms within eighteen seconds. In that short time, many doctors decide on the likely diagnosis and best treatment. Often, decisions made this way are correct, but at crucial moments they can also be wrong -- with catastrophic consequences. In this myth-shattering book, Jerome Groopman pinpoints the forces and thought processes behind the decisions doctors make. Groopman explores why doctors err and shows when and how they can -- with our help -- avoid snap judgments, embrace uncertainty, communicate effectively, and deploy other skills that can profoundly impact our health. This book is the first to describe in detail the warning signs of erroneous medical thinking and reveal how new technologies may actually hinder accurate diagnoses. How Doctors Think offers direct, intelligent questions patients can ask their doctors to help them get back on track.
Groopman draws on a wealth of research, extensive interviews with some of the country's best doctors, and his own experiences as a doctor and as a patient. He has learned many of the lessons in this book the hard way, from his own mistakes and from errors his doctors made in treating his own debilitating medical problems.
How Doctors Think reveals a profound new view of twenty-first-century medical practice, giving doctors and patients the vital information they need to make better judgments together.
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| Customer Reviews: Read 153 more reviews...
 Excellent for doctors and patients October 3, 2008
As an MD and ocxcasional patient, I think this book is a must for all of us. I gave it out as a present to my MD friends, to my private physician and to a cousin who is a very knowledgeable RN. This book is written with modesty, humor and empathy, things which some of us lack. I am not sure that all lay people will get the gist of it, but I recommend it highly.
 Learning to Think Straight September 19, 2008
1 out of 1 found this review helpful
When we're sick, we want to believe the doctor knows best. With authority and confidence, they assess our symptoms and assign a course of treatment, and we go along, perhaps anxiously but comforted by their wisdom just the same.
In "How Doctors Think," Jerome Groopman (himself an oncologist for decades) reveals how rarely doctors are totally sure of their diagnoses--and how when they are, it may be the biggest problem of all. Doctors, like all of us, are prone to thinking errors; for example, they may jump to the most obvious conclusion, or stop thinking when they find "the answer," or any number of other common pitfalls. But when doctors stop thinking, it can result in harm to the patient. Groopman's book explores how and why these mistakes happen, and the consequences they can have.
Luckily, it's not all bad news: far from trying to cast aspersions on the reliability of the medical profession, Groopman firmly believes that doctors can not only train themselves to avoid thinking errors, patients can help them by asking pointed questions during an exam or follow-up. (Groopman touches on such questions throughout, then summarizes them in a brief epilogue.)
Groopman is undoubtedly a doctor before he is a writer, but his style is good-natured, and a wealth of real-life examples makes his sometimes abstract subject matter engaging. "How Doctors Think" is a sometimes surprising, sometimes disturbing, but ultimately optimistic discussion of the ongoing art form that is modern medicine.
~
 it is OK September 19, 2008
0 out of 1 found this review helpful
this book review is mostly about me and not about the book's contents, but it is about doctors.
I have gotten some feedback recently, over the last year, implying that I have a tendency to blame doctors for my problems. and I thought about it and I have to admit that is true.
I have various disabilities and etc. my issue in particular is that due to a cognitive impairment, I go through a process of mental churning when I think through things. it is a feeling of dizziness and pressure in my head. and in the past I have fought that in a way that has negatively impacted other people, in this case, doctors. I do feel bad about that and I understand that I will need to be extremely careful.
my husband is the most fair judge of this and he said that I tend to assume I won't be listened to and then panic. and for example, when I was in the hospital, he said that I continued a conversation he and I were having instead of talking to the doctor.
and I thought about it and I have to admit that is true. I do have a tendency to do that. to assume things will go badly and panic.
my concern is that this book is written with the same negative type slant.
after thinking about it for quite some time, I decided I needed to face my fears and so I am working on it. my fear is that doctors are uncaring and threatening.
the problem is, in the many years I've had appointments, is that I have been living out that fear instead of facing it.
I have to admit that I have tended to think quite a bit of other people's perspectives and that has sometimes led me to a tendency to blame them - it is not always instead of taking responsibility, but in addition to it.
and that is really not OK. I am finding it has a bad effect on people, including the doctors I have been seeing in some cases. :(
the problem is I had a brain injury which means my insight and memory are compromised. the difficulty is that I tend to blame doctors in particular, to fill in the gaps of what I do not understand.
I did think about this feedback I received. sometimes I don't think in time to avoid saying stupid things. but I did think about it, b/c it let me know that something is wrong.
it can take me 5 or 6 solid hours of lying down and doing nothing but thinking through an issue like this to get to a conclusion. I believe the moral is that I need to think before I speak, or type. :)
I hope that this way, my fear and anxiety will be less.
I had a doctor's appointment today. I was really nervous but it went very well. I had a lot of fear and the doctor, who was my allergist, was patient and understanding.
Three C's: Communication, Critical Reasoning and Compassion August 22, 2008
The most powerful messages I got from reading Groopman's How Doctors Think are related to his positions on treatment algorithms and practice guidelines and health care quality.
While many medical professionals consider evidence-based medicine the gold standard of medical practice, Groopman expressed his concern about the detrimental effect it has on doctors' ability to think independently and creatively. He reasoned that strictly adhering to algorithms debilitates doctors' ability to think outside the boxes and limit them from taking into consideration the idiosyncrasy of each individual patient.
Groopman also argued that "quality in primary care means much more than using metrics to judge a physician's quality or keeping a scorecard to ensure blood sugar was messaged and a flu shot given." He gave quality of care a new definition: "Quality means thinking broadly, because any and every problem of human biology can present itself; it means making judicious decisions with limited data about children and adults, neither overreacting nor being blase; it means wielding one's words with precision and with a profound appreciation of the social context of the patients. It means, as a gatekeeper, knowing where to guide us. One of those portals opens to the intensive care unit."
After reading Groopman's viewpoints on evidence-based medicine and quality of care, I can't stop wondering whether the "Pay-for-Performance" program which offers physicians financial incentive for providing "quality of care" based on predefined quality measure target(s) that are in alignment with certain evidence-based clinical guidelines is the direction our nation should follow.
It is disconcerting to find that our current health care reimbursement structure is the hidden cause of some of these cognitive errors. In an era of managed care, many physicians are stretched thin and burned out. They are pushed to see more patients in shorter duration. Under time constraint, physicians are forced to make snap judgment. It is inevitable that they commit cognitive errors or biases (from representative, affective, availability and satisfaction of search error, to confirmation, anchoring and commission bias) because of the time pressure. The cost-driven system also forces them to make decisions based on cost control rather than the best interest of the patients. The fee-for-service payment mechanism reimburses physicians better for procedure rather than consultation, so they will prescribe unnecessary procedure to increase revenue.
Among the many stories in the book that have left lasting impressions on my mind, the one that struck me the most is his narration of his first patient encounter thirty years old on his first day of internship at the Massachusetts General Hospital. He described himself as an intense, driven student carrying a pack of index cards from medical school in his pocket. During his first encounter of emergency medicine in the "real world," he faced a hypertensive patient with a tear through his aortic valve. He tried to think (and response) but couldn't. He was stunted and paralyzed. In this critical moment when it required his "flesh-and-blood decision-making," he failed to make a prompt response. This reality check taught him that his high grades in medical school were meaningless. The index cards in his pockets were just dead weight. It may be hard to believe, but even people who are highly intelligent (and full of confidence) may have difficulty making prompt decision in split second.
Another story that is as intriguing is the incident in which he failed to ask him to roll over so he could examine his buttocks and rectum simply because he felt for his patient and didn't want to cause him extra suffering. He thought he should have examined him more thoroughly and he berated himself for doing a sloppy job. He learned that "physicians must learn to suppress their emotions, to block their natural reactions to many of the awful things they see and the brutal thing they must do to their patients. They have to detach themselves from anguish that could impede their work." It is important to note how our emotion may impede our work performance.
I highly recommend this book to medical students, residents and medical professionals, who will find in this book many invaluable lessons on how to avoid cognitive errors and biases. I will recommend this book to patients, their families and friends, who will find in this book many helpful tips on helping their physicians avoid cognitive pitfalls.
Do Doctors Think? July 26, 2008
2 out of 2 found this review helpful
I am an R.N., and thought I knew how my fellow medical people, the doctors, thought. They acted in unusual ways at times, but I didn't know why. This book is a portal into the ways that the people who hold our lives in their hands, come to some of the decisions that they make. I recommend it highly to all. You don't have to be in it (the medical profession) to be aware. At some time, sooner or later, we and our families and friends become ill. At that time, we all need doctors. It is good to know a little more of their training, and what might make them tick in a certain way. It is well-written, and makes many valid points.
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