Book how doctors think

But research shows that most physicians already have in mind two or three possible diagnoses within minutes of meeting a patient, and that they tend to develop their hunches from very incomplete information. Heuristics are indispensable in medicine; physicians, particularly in emergency rooms, must often make quick judgments about how to treat a patient, on the basis of a few, potentially serious symptoms.

A doctor is trained to assume, for example, that a patient suffering from a high fever and sharp pain in the lower right side of the abdomen could be suffering from appendicitis; he immediately sends the patient for X-rays and contacts the surgeon on call.

But, just as heuristics can help doctors save lives, they can also lead them to make grave errors. In retrospect, Croskerry realized that when he saw McKinley in the emergency room the ranger had been experiencing unstable angina—a surge of chest pain that is caused by coronary-artery disease and that may precede a heart attack.

Doctors make such errors when their thinking is overly influenced by what is typically true; they fail to consider possibilities that contradict their mental templates of a disease, and thus attribute symptoms to the wrong cause. When Croskerry teaches students and interns about representativeness errors, he cites Evan McKinley as an example. Doctors can also make mistakes when their judgments about a patient are unconsciously influenced by the symptoms and illnesses of patients they have just seen.

Many common infections tend to occur in epidemics, afflicting large numbers of people in a single community at the same time; after a doctor sees six patients with, say, the flu, it is common to assume that the seventh patient who complains of similar symptoms is suffering from the same disease.

Harrison Alter, an emergency-room physician, recently confronted this problem. At the time, Alter was working in the emergency room of a hospital in Tuba City, Arizona, which is situated on a Navajo reservation.

In a three-week period, dozens of people had come to his hospital suffering from viral pneumonia. One day, Blanche Begaye a pseudonym , a Navajo woman in her sixties, arrived at the emergency room complaining that she was having trouble breathing. Begaye was a compact woman with long gray hair that she wore in a bun.

She told Alter that she had begun to feel unwell a few days earlier. At first, she said, she had thought that she had a bad head cold, so she had drunk orange juice and tea, and taken a few aspirin. But her symptoms had got worse. Alter noted that she had a fever of He listened to her lungs but heard none of the harsh sounds, called rhonchi, that suggest an accumulation of mucus.

However, a blood test to measure her electrolytes revealed that her blood had become slightly acidic, which can occur in the case of a major infection. He ordered her to be admitted to the hospital and given intravenous fluids and medicine to bring her fever down. Alter referred Begaye to the care of an internist on duty and began to examine another patient. A few minutes later, the internist approached Alter and took him aside.

Immediately, Alter knew that the internist was right. Aspirin toxicity occurs when patients overdose on the drug, causing hyperventilation and the accumulation of lactic acid and other acids in the blood. She was an absolutely classic case—the rapid breathing, the shift in her blood electrolytes—and I missed it.

I got cavalier. This tendency was first described in , in a paper by Amos Tversky and Daniel Kahneman, psychologists at the Hebrew University of Jerusalem. For example, a businessman may estimate the likelihood that a given venture could fail by recalling difficulties that his associates had encountered in the marketplace, rather than by relying on all the data available to him about the venture; the experiences most familiar to him can bias his assessment of the chances for success.

Kahneman won the Nobel Prize in Economics in , for his research on decision-making under conditions of uncertainty. The diagnosis of subclinical pneumonia was readily available to Alter, because he had recently seen so many cases of the infection. He dismissed the data that contradicted his diagnosis—the absence of rhonchi and of white streaks on the chest X-ray, and the normal white-blood-cell count—as evidence that the infection was at an early stage.

In fact, this information should have made him doubt his hypothesis. After the internist made the correct diagnosis, Alter recalled his conversation with Begaye.

Representativeness and availability errors are intellectual mistakes, but the errors that doctors make because of their feelings for a patient can be just as significant. We all want to believe that our physician likes us and is moved by our plight. Doctors, in turn, are encouraged to develop positive feelings for their patients; caring is generally held to be the cornerstone of humanistic medicine. In , I treated Brad Miller a pseudonym , a young literature instructor who was suffering from bone cancer.

I was living in Los Angeles at the time, completing a fellowship in hematology and oncology at the U. Medical Center. I told Brad that I hoped he would be able to run again soon, though I warned him that his chemotherapy treatment would be difficult.

About six weeks earlier, Brad had noticed an ache in his left knee. He had been training to run in a marathon, and at first he thought that the ache was caused by a sore muscle. He saw a specialist in sports medicine, who examined the leg and recommended that he wear a knee brace when he ran. Brad followed this advice, but the ache got worse. The physician ordered an X-ray, which showed an osteosarcoma, a cancerous growth, around the end of the femur, just above the knee.

Several years earlier, the surgical-oncology department at U. Not only did it cause severe nausea, vomiting, mouth blisters, and reduced blood counts; repeated doses could injure cardiac muscle and lead to heart failure. Mar 19, Assia Mohdeb rated it it was amazing. Do different doctors think differently? Are different forms of thinking more or less prevalent among the different specialties? In other words, do surgeons think differently from internists, who think differently from pediatricians?

Is there one "best" way to think, or are there multiple, alternative styles that can reach a correct diagnosis and choose the most effective treatment? How does a doctor think when he is forced to improvise, when confronted with a problem for which there is little or no precedent? How does a doctor's thinking differ during routine visits versus times of clinical crisis? Do a doctor's emotions—his like or dislike of a particular patient, his attitudes about the social and psychological makeup of his patient's life—color his thinking?

Why do even the most accomplished physicians miss a key clue about a person's true diagnosis, or detour far afield from the right remedy? In sum, when and why does thinking go right or go wrong in medicine? Oct 30, Cara rated it really liked it. An interesting enough look at the human failings of doctors: misdiagnoses and why they occur, the influence of pharmaceutical companies, fear of failure causing poor treatment, etc.

I found the most interesting part to be why doctors misdiagnose patients: it's not incompetence, usually, but rather cognitive errors. The author interviewed several doctors and got very honest stories about what their biggest known failures were and their reflections on them. He also offers very useful suggestions An interesting enough look at the human failings of doctors: misdiagnoses and why they occur, the influence of pharmaceutical companies, fear of failure causing poor treatment, etc.

He also offers very useful suggestions for patients on what to say to their doctors to help them think better, and other suggestions for doctors on how to avoid cognitive errors. Groopman seems rather critical of evidence-based medicine, though he doesn't explain his stance very well.

Yes, Bayesian analysis isn't always useful, but it is much of the time. Groopman suggests extra tests, and repeating tests, but in reality doctors don't have infinite time and patients don't have unlimited money, and sometimes whether we like it or not, we have to cut corners. Groopman is sometimes unrealistic about this aspect of medicine. Apr 26, charlie rated it really liked it Shelves: non-fiction. I really should not have read this book!

It confirmed all of my worst assumptions about doctors - how little they know, how so many factors can influence their diagnoses and approaches, how visiting 5 different doctors may yield 5 different perspectives. All that being said, I am glad I read this book since the author, to some extent, gives you strategies on how to manage or select doctors to improve care.

In the end, I am not sure I am that much wiser, but I appreciated that one doctor the aut I really should not have read this book! In the end, I am not sure I am that much wiser, but I appreciated that one doctor the author is being honest about what to expect from this very inexact science. Aug 30, Monica Willyard Moen rated it really liked it Shelves: personal-growth , medical , favorites , kindle , bookshare.

I think the ideas in this book will help me become a better patient and will help me communicate better with the many doctors I see managing various health conditions. I made a difficult decision of removing a member of my support team this year, and reading this book helped me put into words why that needed to happen. It also helped me see clearly that I did make considerable effort to fix the communication before taking that step, and I feel better about it now. I know I will read parts of thi I think the ideas in this book will help me become a better patient and will help me communicate better with the many doctors I see managing various health conditions.

I know I will read parts of this book again before seeing a new doctor in September. I have hopes of building a productive and mutually respectful relationship with that doctor and think I have the confidence to do it now. Oct 09, Andrew Griffith rated it really liked it. Some of my comments and lessons from the book. Doctors, like all of us, are subject to many of the 'fast thinking' pattern recognition System 1 , to use Kahneman's phrase as all of us.

According to one study cited by Groopman, some 80 percent of misdiagnoses could be attributed to a cascade of cognitive errors, not lack of medical knowledge. Groopman walks through a large number of examples from a range of medical fields to illustrate some of the more common cognitive errors: - Attribution errors, Some of my comments and lessons from the book.

Groopman walks through a large number of examples from a range of medical fields to illustrate some of the more common cognitive errors: - Attribution errors, particularly when patients fit negative stereotypes; - Affective errors, when we follow our wishes, or treat someone we like; - Availability, based upon the ease which relevant examples come to mind, e.

Some good questions patients can use to slow down the thinking of doctors: Questions: - What's the worst thing this can be? The book also has some good insights into some of the perverse incentives, either from drug companies or from fee-for-service that may cloud physician judgement. Overall, a good, interesting and helpful read.

Favourite quote and advice: "Informed choice means, in part, learning how different doctors think about a particular medical problem and how science, tradition, financial incentives and personal bias mold that thinking. There is no single source for all of this information, so a patient and family should ask the doctor whether a proposed treatment is standard or whether different specialists recommend different approaches, and why. Laypeople also should inquire about how time-tested a new treatment is.

Jan 01, Greg rated it it was amazing Shelves: biography , medical. This book helped me make decisions that gave me the patience to weather many tests and consultations that led to the discover of my coronary artery disease before I got a heart attack.

Doctors are people too. They are trying to make a living and doing the best they can. Don't hate them because the prescribe expensive drugs or inconclusive tests. You need to work with them and force them to communicate their thinking. Always ask why a test is being administered. When a diagnosis is made, always a This book helped me make decisions that gave me the patience to weather many tests and consultations that led to the discover of my coronary artery disease before I got a heart attack.

When a diagnosis is made, always ask: 1 What else could be the problem? What other body parts are near the region where I am experiencing symptoms? When looking for a thinking doctor, look for 1 Communication 2 Critical reasoning: the doctor should explain the thought processes that generated the diagnosis 3 Compassion: respect for the patient's values and spiritual needs. When diagnosing, not only doctors do this! This may be driven by a wish for a certain outcome. This is an excellent read, both for physicians and those in medicine, and for patients.

Groopman discusses errors in thinking physicians make, and offers suggestions to work around them. Specific chapters deal with errors in primary care, where you are looking for the one sick patient in the sea of healthy ones every day, to errors in very specific subspecialities such as pediatric cardiology, where we must not forget we are making some of this up as we go along, as each patient is unique and re This is an excellent read, both for physicians and those in medicine, and for patients.

Specific chapters deal with errors in primary care, where you are looking for the one sick patient in the sea of healthy ones every day, to errors in very specific subspecialities such as pediatric cardiology, where we must not forget we are making some of this up as we go along, as each patient is unique and requires a specialized treatment plan.

The chapter on radiology and diagnostic imaging was eye opening; a good reminder that even thorough radiologists can miss non-subtle findings on films, and the clinician will get more information if she provides a more detailed patient history. Read the epilogue if you want a great summary--it reviews how to help your physician come to the best diagnosis. Key questions to ask: 1. Can I tell you the story again from the beginning?

Perhaps there's something I forgot to mention. Sometimes listening afresh provides more insight. What else could it be, or what is the worst thing this could be? Do we need to repeat tests or blood work? Sometimes a radiologic study can be re-examined, or repeated for better clarity. Could it be more than one problem? Occom's razor, the idea that the simplest solution is best, or that all symptoms need to lead to one unifying diagnosis, is not always true.

Is there another physician or center that would have more insight into my problem? Sometimes a change in physician can help all. A note for the author: Half of all medical students are now female. Your wife is a physician and female.

Many female physicians are reading your book. It is jarring to read "he" every time we discuss the generic doctor and her thought processes.

Like the other Groopman book I read, this one is pretty much all anecdotes, that favorite tool of non-fiction writers that don't seem to trust readers with non-narrative information. The problem with that is that one person's story can illustrate a point, but should not become the point. So many books do this, and I notice that people now expect "proof" to exist of a single example. The anecdotal evidence fallacy is alive and well in non-fiction. But I digress Anecdotes can be interesting, bu Like the other Groopman book I read, this one is pretty much all anecdotes, that favorite tool of non-fiction writers that don't seem to trust readers with non-narrative information.

Anecdotes can be interesting, but that doesn't mean they are particularly helpful. While this book gives lots of examples of physicians decision-making processes, to what end? There's not really anything here that can help the patient -- excuse me, the medical consumer -- counter the potential of being on the receiving end of poor decisions.

We already know that doctors are human, and humans are fallible. Most of us probably are already aware that doctors tend to have huge egos and probably need them to get through their training , and that the power balance between patient and doctor is seldom equal: doctors tend to present as authority figures.

Discussion of how people dealing with doctors could spot and counter the examples given would have made the book more useful. Oct 06, Ali rated it it was amazing. Very similar to malaysian book Diagnosis, what i learnt here are: 1. Doctors made errors 2. Make sure to complete examination, because you may miss what important 3.

Misdiagnosis or another diagnosis are possible with same symptom 4. To provide a quality care require a lot of than just making decision? A patient that curious about the illnesses and in search of its information are rare and can help in finding out what actual problem is 6. In some situation, a doctor need to be honest fully of what Very similar to malaysian book Diagnosis, what i learnt here are: 1.

In some situation, a doctor need to be honest fully of what they know, and what they don't know as it sometimes leads to success. There is no use with modern technology if the Dr are only rushing to conclusion with little proof 8. Informed choice is necessary, sometimes it helps the patient to make decision by themselves. A serious ilness such as cancer can make patient dizzy in making decision, this is where the Dr needs to be straight and true.

Jul 04, Michael Gray rated it really liked it. This is a thorough and honest review of the complex process of clinical decision-making in the modern healthcare environment. Groopman uses compelling stories from his own clinical encounters and those of his colleagues to lay out the internal and environmental factors which influence the way we think and act. Often this influence occurs subconsciously. By bringing attention to the wide ranging factors that can affect quality of care from time constraints and financial incentives to cognitiv This is a thorough and honest review of the complex process of clinical decision-making in the modern healthcare environment.

By bringing attention to the wide ranging factors that can affect quality of care from time constraints and financial incentives to cognitive biases and communication errors , Dr. Groopman calls for doctors to think about their thinking and for patients to ask the questions that encourage them to do so. These are essential concepts for a healthcare provider to review regularly. As a clinician myself, I expect to use this book for reference and for accountability for years to come.

Jan 21, Imene Gouichiche rated it it was amazing. A must reading book for both patients and doctors! I also realized that we mu A must reading book for both patients and doctors! I also realized that we must always questioned ourselves even if we have achieve a great deal of knowledge , there will be always something to learn! Very pleasing book, I will certainly read it again in few years after having had more experiences with patients, I am sure I will learn more.

Doctors are human beings and as such, can have biases in how they practice medicine. Doctors will prescribe the few dozen medicines that they've always prescribed and will recommend treatments that they specialize in. After all, it's what they know and in the fierce business of providing healthcare, they don't have the time to research new medicines launched every year. How Doctors Think reveals a profound new view of 21st-century medical practice, giving doctors and patients the vital information they need to make better judgments together.

A highly pleasurable must-read. Every reflective doctor will learn from this book However, I was disappointed in the content of the book. This does not really tell us too much about how doctors think; what constitutes the complexity of a diagnosis or how doctors make decisions. Rather, it is more of a collection of stories about misdiagnosis or mistreatment of patients and friends of Dr.

And it turns out that Groopman is mostly the hero of the book -- either making the tough diagnosis himself or referring to one of his friends who saves the day.

Not exactly the answer for the masses of Americans belonging to HMOs who cannot even get a specialty referral without a letter to a congressman.

The book starts out addressing the theme that young doctors are becoming too entranced with algorithmic medicine. He complains that they follow guidelines for care like robots on an assembly line.

Most would agree, however, that the bigger problem in American medical care is the failure of doctors to adhere to evidence-based guidelines, rather than over-reliance on them. Care for diabetics, asthmatics, and hypertensives fall far short of what it should be and what would improve the health of the nation.

Groopman does share our pain, however. He had a day of distress because a doctor called him at home with a fatal mis-diagnosis while his wife was away skiing. He had the diagnosis corrected the next day at work, but lost a night's sleep over it.

Once you get past the self-congratulations, the old-boy network of super-docs, the confessions of imperfection in himself, and the self-pity; there are a few good points. Get a second opinion. Be an informed consumer. Ask questions 3. If you do not like your doctor, get another one. Not worth the read to learn these lessons. To begin with, the narration was horrible.

I am a doctor and had looked forward to this book with great enthusiasm. However the narrator's dry, business-like narration sounded like the worst stereotype of a condescending paternalistic doctor one could imagine. But to make things worse he frequently and repeatedly mispronounced medical terms. How hard would it have been to make a list of terms he did not recognize and ask Groopman how to say them?

As far as the book goes, it was generally excellent, and I have found it very instrumental in guiding my own thinking and avoiding mistakes. There were some sections that were silly, for example there is a section in which his fellow temple congregant, a mother named Rachel, underwent an ordeal in which a child she adopted got very sick. He spent way too much time on this chapter and focused, nearly obsessively, on her religious reflections which did nothing to advance the points he was making.

At other times he was repetitious. For the most part, however, this was an exhilarating and a refreshing way to look at medical errors and medical decision making, and is getting the attention it more than deserves from medical circles. This book provides a fascinating insight into medical decision making in the absence of hard evidence and lives at stake. At the end of the book, I definitely had a much better feel for what doctors could reasonably know when making diagnoses and decide on treatment and how difficult it must be to recommend paths forward for medical interventions.

One thing I definitely took away from this book is that doctors are not all-knowing and when in doubt, do get a second opinion even if it is just to get a sense of how differing opinions about a certain condition really are Great book, I have already recommended it to many of my friends and colleages as a "must read".

I really enjoy Jerome Groopman's columns in the New Yorker, but the book made him seem stiff, repetitive, and pompous. All the observations seemed trite and obvious and none of his case studies held my interest for their length. Even worse, the reader read everything in a flat monotone, reminiscent of a s educational tape e. Do not attempt this book while driving -- your mind will wander and you will fall asleep.