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
  • Critics' Opinion:

    Readers' Opinion:

  • First Published:
    Mar 2007, 320 pages
    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 your next great read!

Join Today!

Editor's Choice

  • Book Jacket
    Auntie Poldi and the Sicilian Lions
    by Mario Giordano
    Munich matron and self-described worldly sophisticate, Isolde Oberreiter, has decided to retire to a...
  • Book Jacket: Of Arms and Artists
    Of Arms and Artists
    by Paul Staiti
    In the late eighteenth-century, the United States of America was still an emerging country, ...
  • Book Jacket: So Say the Fallen
    So Say the Fallen
    by Stuart Neville
    Noir crime fiction – Raymond Chandler, Dashiell Hammett anyone? – is an American invention...
Book Discussions
Book Jacket
The Bone Tree
by Greg Iles

An epic trilogy of blood and race, family and justice.

About the book
Join the discussion!

First Impressions

  • Book Jacket

    The Comet Seekers
    by Helen Sedgwick

    A magical, intoxicating debut novel, both intimate and epic.

    Read Member Reviews

  • Book Jacket

    Les Parisiennes
    by Anne Sebba

    How the women of Paris lived, loved, and died under Nazi occupation.

    Read Member Reviews

  • Book Jacket

    The Next
    by Stephanie Gangi

    Fast-paced, wickedly observant, and haunting in the best sense of the word.

    Read Member Reviews

Win this book!
Win The World of Poldark

Win the book & DVD

Enter to win The World of Poldark and the full first series on DVD.


Word Play

Solve this clue:

One S D N M A S

and be entered to win..

Books that     

 & 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.


Free Weekly Newsletter

Keep up with what's happening in the world of books:
Reviews, previews, interviews and more!

Spam Free: Your email is never shared with anyone; opt out any time.