Excerpt from How Doctors Think by Jerome Groopman, plus links to reviews, author biography & more

Summary |  Excerpt |  Reviews |  Beyond the Book |  Readalikes |  Genres & Themes |  Author Bio

How Doctors Think

by Jerome Groopman

How Doctors Think by Jerome Groopman
  • Critics' Opinion:

    Readers' Opinion:

  • First Published:
    Mar 2007, 320 pages
    Paperback:
    Mar 2008, 336 pages

  • Rate this book


Book Reviewed by:
BookBrowse Review Team

Buy This Book

About this Book

Print Excerpt


When Falchuk told me that “the picture didn’t fit,” his words were more than mere metaphor. Donald Redelmeier, a physician at Sunnybrook Health Sciences Centre in Toronto, has a particular interest in physician cognition and its relation to diagnosis. He refers to a phenomenon called the “eyeball test,” the pivotal moment when a doctor identifies “something intangible yet unsettling in the patient’s presentation.” That instinct may, of course, be wrong. But it should not be ignored, because it can cause the physician to recognize that the information before him has been improperly “framed.”

Doctors frame patients all the time using shorthand: “I’m sending you a case of diabetes and renal failure,” or “I have a drug addict here in the ER with fever and a cough from pneumonia.” Often a doctor chooses the correct frame and all the clinical data fit neatly within it. But a self-aware physician knows that accepting the frame as given can be a serious error. Anne Dodge was fitted into the single frame of bulimia and anorexia nervosa from the age of twenty. It was easily understandable that each of her doctors received her case in that one frame. All the data fit neatly within its borders.

There was no apparent reason to redraw her clinical portrait, to look at it from another angle. Except one. “It’s like DNA evidence at a crime,” Falchuk explained. “The patient was saying ‘I told you, I’m innocent.’” Here is the art of medicine, the sensitivity to language and emotion that makes for a superior clinician.

Falchuk almost rose from his chair when he showed me the pictures of Dodge’s distorted small intestine taken through the endoscope. “I was so excited about this,” he said. He had the sweet pleasure of the detective who cracks the mystery, a legitimate pride in identifying a culprit.

But beyond intellectual excitement and satisfaction, he showed his joy in saving a life.

Intellect and intuition, careful attention to detail, active listening, and psychological insight all coalesced on that December day. It could have been otherwise. Anne Dodge, with her history of anorexia nervosa and bulimia, may then have developed irritable bowel syndrome. But Falchuk had asked himself, “What might I be missing in this case? And what would be the worst thing that could be missed?” What if he had not asked himself these questions? Then Anne Dodge, her boyfriend, or a family member could have asked them — perhaps many years earlier. Of course, a patient or a loved one is not a doctor. They lack a doctor’s training and experience. And many laymen feel inhibited about asking questions. But the questions are perfectly legitimate. Patients can learn to question and to think the way a doctor should. In the chapters and epilogue that follow, we will examine the kinds of errors in thinking that physicians can make, and the words that patients and their loved ones can offer to prevent these cognitive mistakes.

In Anne Dodge’s case, it was Falchuk who asked simple but ultimately life-saving questions, and to answer them he needed to go further. And Anne Dodge needed to agree to go further, to submit to more blood tests and an invasive procedure. For her to assent, she had to trust not only Falchuk’s skill but also his sincerity and motivations. This is the other dimension of Roter’s and Hall’s studies: how language, spoken and unspoken, can give information essential to a correct diagnosis, and persuade a patient to comply with a doctor’s advice. “Compliance” can have a negative connotation, smacking of paternalism, casting patients as passive players who do what the all-powerful physician tells them. But according to Roter’s and Hall’s research, without trust and a sense of mutual liking, Anne Dodge probably would have deflected Falchuk’s suggestions of more blood tests and an endoscopy. She would have been “noncompliant,” in pejorative clinical parlance. And she would still be struggling to persuade her doctors that she was eating three thousand calories a day while wasting away.

Copyright © 2007 by Jerome Groopman. Reprinted by permission of Houghton Mifflin Company.

Membership Advantages
  • Reviews
  • "Beyond the Book" backstories
  • Free books to read and review (US only)
  • Find books by time period, setting & theme
  • Read-alike suggestions by book and author
  • Book club discussions
  • and much more!
  • Just $10 for 3 months or $35 for a year
  • More about membership!

Support BookBrowse

Become a Member and discover books that entertain, engage & enlighten!

Join Today!

Editor's Choice

  • Book Jacket: Forest Dark
    Forest Dark
    by Nicole Krauss
    In Forest Dark, Nicole Krauss presents parallel stories of two people who leave New York to stay in ...
  • Book Jacket: The Amber Shadows
    The Amber Shadows
    by Lucy Ribchester
    The Amber Shadows sweeps readers into the realm of World War II-era Britain where Honor "Honey" ...
  • Book Jacket: Midwinter Break
    Midwinter Break
    by Bernard MacLaverty
    Northern Ireland's Bernard MacLaverty is the author of five novels and multiple short story ...

Book Discussion
Book Jacket
Being Mortal by Atul Gawande

An eye-opening and riveting look at how how medicine can not only improve life but also the process of its ending.

About the book
Join the discussion!

First Impressions

  • Book Jacket

    The Twelve-Mile Straight
    by Eleanor Henderson

    An audacious epic set in rural Georgia during the years of the Depression and Prohibition.
    Reader Reviews

  • Book Jacket

    Love and Other Consolation Prizes
    by Jamie Ford

    Inspired by a true story, about a boy whose life is transformed at Seattle's epic 1909 World's Fair.
    Reader Reviews

Win this book!
Win If the Creek Don't Rise

If the Creek Don't Rise

A debut novel bursting with heart, honesty, and homegrown grit.

Enter

Word Play

Solve this clue:

Y Can't M A S P O O A S E

and be entered to win..

Books that     
entertain,
     engage

 & enlighten

Visitors can view some of BookBrowse for free. Full access is for members only.

Join Today!

Your guide toexceptional          books

BookBrowse seeks out and recommends books that we believe to be best in class. Books that will whisk you to faraway places and times, that will expand your mind and challenge you -- the kinds of books you just can't wait to tell your friends about.