“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.”

Essential Book Information

Jerome Groopman, M.D. is the Dina and Raphael Recanati Professor of Medicine at Harvard Medical School, Chief of Experimental Medicine at Beth Israel Deaconess Medical Center, and one of the world’s leading researchers in cancer and AIDS. He gives a unique perspective about the thought processes behind the decision-making of a doctor and how this can be improved upon.

Basic Plot Summary

This book discusses how doctors are conditioned to think, how they reach wrong or right diagnoses, and how the physician’s and patient’s personality, and the interaction between the two, can impact diagnosis.

The book is loosely organised in the same way that a physician works through an issue with a patient: history, physical examination, laboratory tests, differential diagnosis, treatment, and other variables that may impact a physician’s opinion about the chief complaint of the patient.

Review

Groopman is a doctor afflicted with a wrist injury and multiple visits to doctors with no logical and straightforward diagnosis presented. As a result, he sets out on a quest to learn more about how doctors think.

Groopman explains why and how doctors make diagnostic mistakes through several interviews with doctors and patients in Boston and San Francisco hospitals. Along the way, he gives some very helpful advice on how to: speak to your doctor, question your doctor, help your doctor, and in some cases, what you can learn from a new doctor.  He also acknowledges and describes the importance of getting a second opinion

Groopman lays out the internal and external factors that affect how we think and behave using convincing accounts from his own clinical experiences and those of his colleagues. He presents cases in each chapter in which specific diagnoses were made in error, often by different, but not always independently thought, physicians.

He also discusses situations in which complex diagnoses were correctly made, emphasising the significant discrepancies between the cognitive mechanisms at work in each case and the end result. He also illustrates many types of common cognitive mistakes made by doctors in this way.

Dr. Groopman encourages physicians to learn about their thinking and patients to ask the questions that allow them to do so by drawing attention to the broad range of variables that can influence quality of treatment (from time constraints and financial rewards to cognitive biases and communication errors). A healthcare professional should revisit these principles on a regular basis.

Misdiagnosis, unlike simple mistakes such as performing the wrong test, is “a window into the medical mind,” exposing “why doctors struggle to doubt their hypotheses, why their thought is often closed or distorted, why they underestimate the gaps in their knowledge,” according to Groopman.

According to one report he cites: up to 15% of patients are given incorrect diagnoses, a result that matches autopsy studies. The chapter on radiology and diagnostic imaging was eye-opening. It served as a good reminder that even the most comprehensive radiologists might overlook non-subtle findings on films and that a more extensive patient history would provide the clinician with more details.
The numerous patient stories he recounts in this book maintain the pace, while still providing readers with real-life stories of people who have faced difficult medical challenges and how they were eventually able to get the help they needed.

Recommendation

This is a good book about understanding what and how a doctor should think about a patient’s condition, treatment and taking a holistic approach to improve the quality of care.

The language is simple, and examples are provided to aid comprehension. Anyone thinking about pursuing medicine as a profession (even for a general audience) should read this book, as it helps to broaden the medical perspective.

Rating

4.5/5

This book discusses what goes through a doctor’s mind when treating a patient. At the end of it, you’ll be able to answer some of Dr. Jerome Groopman’s initial questions, such as: How does a doctor think? Do different physicians have different perspectives? Is it true that different ways of thought are more or less predominant in different specialties? Is there a single “right” way of thinking, or are there a number of methods that can lead to a correct diagnosis and the most appropriate treatment? When a doctor sees a patient on a regular basis, versus when a patient is in a clinical crisis, how does his or her reasoning differ? Do a doctor’s emotions—their feelings for or against a specific patient, their views on the social and psychological makeup of their patient’s life—influence his decisions? Why can even the most skilled doctors skip a crucial hint about a patient’s true diagnosis or stray too far from the correct treatment?

To summarise, when and why does medical reasoning go right or wrong? And how do ordinary people assist doctors in improving their reasoning in order to avoid the cognitive traps that lead to poor patient care?

A point to note: Women are an indispensable part of the medical field. When we talk about the stereotypical doctor and her thinking patterns, it’s odd to hear “he” every time.

Review compiled by Kashish Malhotra, India, 2021 Executive Committee: Dean of Academy.