Get The BookBrowse Anthology, our 880 page collection of our past decade of Best of Year reviews, now available in hardcover!

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
  • BookBrowse Review:
  • Critics' Consensus (8):
  • Readers' Rating (21):
  • First Published:
  • Mar 19, 2007, 320 pages
  • Paperback:
  • Mar 2008, 336 pages
  • Rate this book

About this Book

Print Excerpt


The trunk of the clinical decision tree is a patient’s major symptom or laboratory result, contained within a box. Arrows branch from the first box to other boxes. For example, a common symptom like “sore throat” would begin the algorithm, followed by a series of branches with “yes” or “no” questions about associated symptoms. Is there a fever or not? Are swollen lymph nodes associated with the sore throat? Have other family members suffered from this symptom? Similarly, a laboratory test like a throat culture for bacteria would appear farther down the trunk of the tree, with branches based on “yes” or “no” answers to the results of the culture. Ultimately, following the branches to the end should lead to the correct diagnosis and therapy.

Clinical algorithms can be useful for run-of-the-mill diagnosis and treatment — distinguishing strep throat from viral pharyngitis, for example. But they quickly fall apart when a doctor needs to think outside their boxes, when symptoms are vague, or multiple and confusing, or when test results are inexact. In such cases — the kinds of cases where we most need a discerning doctor — algorithms discourage physicians from thinking independently and creatively. Instead of expanding a doctor’s thinking, they can constrain it.

Similarly, a movement is afoot to base all treatment decisions strictly on statistically proven data. This so-called evidence-based medicine is rapidly becoming the canon in many hospitals. Treatments outside the statistically proven are considered taboo until a sufficient body of data can be generated from clinical trials. Of course, every doctor should consider research studies in choosing a therapy. But today’s rigid reliance on evidence-based medicine risks having the doctor choose care passively, solely by the numbers.

Statistics cannot substitute for the human being before you; statistics embody averages, not individuals. Numbers can only complement a physician’s personal experience with a drug or a procedure, as well as his knowledge of whether a “best” therapy from a clinical trial fits a patient’s particular needs and values.

Each morning as rounds began, I watched the students and residents eye their algorithms and then invoke statistics from recent studies. I concluded that the next generation of doctors was being conditioned to function like a well-programmed computer that operates within a strict binary framework. After several weeks of unease about the students’ and residents’ reliance on algorithms and evidence-based therapies alone, and my equally unsettling sense that I didn’t know how to broaden their perspective and show them otherwise, I asked myself a simple question: How should a doctor think?

This question, not surprisingly, spawned others: 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? (Here algorithms are essentially irrelevant and statistical evidence is absent.) 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?

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

Membership Advantages
  • Reviews
  • "Beyond the Book" articles
  • 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 $60 for 12 months or $20 for 3 months.
  • More about membership!

BookBrowse Book Club

  • Book Jacket
    The Devil Finds Work
    by James Baldwin
    A book-length essay on racism in American films, by "the best essayist in this country" (The New York Times Book Review).
  • Book Jacket
    The Mysterious Bakery on Rue de Paris
    by Evie Woods
    From the million-copy bestselling author of The Lost Bookshop.
  • Book Jacket
    The River Knows Your Name
    by Kelly Mustian
    A haunting Southern novel about memory and love, from the author of The Girls in the Stilt House.
  • Book Jacket
    Real Americans
    by Rachel Khong
    From the author of Goodbye, Vitamin, a novel exploring family, identity, and the shaping of destiny.

Members Recommend

  • Book Jacket

    One Death at a Time
    by Abbi Waxman

    A cranky ex-actress and her Gen Z sobriety sponsor team up to solve a murder that could send her back to prison in this dazzling mystery.

  • Book Jacket

    The Seven O'Clock Club
    by Amelia Ireland

    Four strangers join an experimental treatment to heal broken hearts in Amelia Ireland's heartfelt debut novel.

  • Book Jacket

    The Fairbanks Four
    by Brian Patrick O’Donoghue

    One murder, four guilty convictions, and a community determined to find justice.

  • Book Jacket

    Happy Land
    by Dolen Perkins-Valdez

    From the New York Times bestselling author, a novel about a family's secret ties to a vanished American Kingdom.

Who Said...

We should have a great fewer disputes in the world if words were taken for what they are

Click Here to find out who said this, as well as discovering other famous literary quotes!

Wordplay

Solve this clue:

J of A T, M of N

and be entered to win..

Your guide toexceptional          books

BookBrowse seeks out and recommends the best in contemporary fiction and nonfiction—books that not only engage and entertain but also deepen our understanding of ourselves and the world around us.