Much has been made of the power of intuition, and certainly initial impressions formed in a flash can be correct. But as we hear from a range of physicians, relying too heavily on intuition has its perils. Cogent medical judgments meld first impressions gestalt with deliberate analysis. This requires time, perhaps the rarest commodity in a healthcare system that clocks appointments in minutes. What can doctors and patients do to find time to think? I explore this in the pages that follow.
Today, medicine is not separate from money. How much does intense marketing by pharmaceutical companies actually influence either conscious or subliminal decision-making? Very few doctors, I believe, prostitute themselves for profit, but all of us are susceptible to the subtle and not so subtle efforts of the pharmaceutical industry to sculpt our thinking. That industry is a vital one; without it, there would be a paucity of new therapies, a slowing of progress. Several doctors and a pharmaceutical executive speak with great candor about the reach of drug marketing, about how natural aspects of aging are falsely made into diseases, and how patients can be alert to this.
Cancer, of course, is a feared disease that becomes more likely as we grow older. It will strike roughly one in two men and one in three women over the course of their lifetime. Recently there have been great clinical successes against types of cancers that were previously intractable, but many malignancies remain that can be, at best, only temporarily controlled. How an oncologist thinks through the value of complex and harsh treatments demands not only an understanding of science but also a sensibility about the soul how much risk we are willing to take and how we want to live out our lives. Two cancer specialists reveal how they guide their patients choices and how their patients guide them toward the treatment that best suits each patients temperament and lifestyle.
At the end of this journey through the minds of doctors, we return to language. The epilogue offers words that patients, their families, and their friends can use to help a physician or surgeon think, and thereby better help themselves. Patients and their loved ones can be true partners with physicians when they know how doctors think, and why doctors sometimes fail to think. Using this knowledge, patients can offer a doctor the most vital information about themselves, to help steer him toward the correct diagnosis and offer the therapy they need. Patients and their loved ones can aid even the most seasoned physician avoid errors in thinking. To do so, they need answers to the questions that I asked myself, and for which I had no ready answers.
Not long after Anne Dodges visit to Dr. Myron Falchuk, I met with him in his office at Bostons Beth Israel Deaconess Medical Center. Falchuk is a compact man in his early sixties with a broad bald pate and lively eyes. His accent is hard to place, and his speech has an almost musical quality. He was born in rural Venezuela and grew up speaking Yiddish at home and Spanish in the streets of his village. As a young boy, he was sent to live with relatives in Brooklyn. There he quickly learned English. All this has made him particularly sensitive to language, its nuances and power. Falchuk left New York for Dartmouth College, and then attended Harvard Medical School; he trained at the Peter Bent Brigham Hospital in Boston, and for several years conducted research at the National Institutes of Health on diseases of the bowel. After nearly four decades, he has not lost his excitement about caring for patients. When he began to discuss Anne Dodges case, he sat up in his chair as if a jolt of electricity had passed through him.
She was emaciated and looked haggard, Falchuk told me. Her face was creased with fatigue. And the way she sat in the waiting room so still, her hands clasped together I saw how timid she was. From the first, Falchuk was reading Anne Dodges body language. Everything was a potential clue, telling him something about not only her physical condition but also her emotional state. This was a woman beaten down by her suffering. She would need to be drawn out, gently.
Copyright © 2007 by Jerome Groopman. Reprinted by permission of Houghton Mifflin Company.
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