How Doctors Think Kindle Edition

Talks about how doctors only listen to you for about 20 secs before formulating a diagnosis. This is 100% true in most of medicine these days. Each chapter is a case history. Informative and relevant

I purchased both the book and the audio CD. After listening to the CD I circulated an e - mail to my friends saying : " Everybody ought to read How Doctors Think by Dr. Jerome E. Groopman. Read it whether you are a doctor or not. As a doctor or as a patient you may have experienced similar unfortunate events explained in the book. In that case read the book to never go through the same events. If you have not gone through such experiences read the book so that you will never have to suffer from similar inconveniences."Although a recent book "How doctors think " by Dr. Jerome E Groopman of Harvard Medical School has already caught a lot of attention and has been translated to different languages and is being sold in various countries. I am not a doctor. As patients my family and I have had to resort to the services of doctors many times. Not necessarily for big illnesses, sometimes only for check ups. In general we are quite healthy. I was attracted by the title of the book. Dr. Groopman explains very clearly what goes on in the minds of both the doctors and their patients and how their thinking styles affect their communication, the diagnoses and treatments. He gives many examples from many different branches of medicine. Everybody would agree with the assertion that better communication between patients and doctors is necessary. But how ? It is the how that Dr. Groopman explains. He shows the flawed thinking patterns in many doctors' thinking with actual detailed case studies leading to wrong diagnoses and treatments and how the doctor's thinking and reasoning should have been in each case. He says that some doctors jump to conclusions when they find a possible cause for a malady without searching for alternative causes that maybe more likely. He proposes a thinking method which generates many alternative explanations and working through the most likely ones before reaching a conclusion. This method seemed to me very similar to some of the correct thinking methods explained by a leading authority on the thinking subject : Dr. Edward de Bono.Another issue that Dr. Groopman emphasizes is the need for better listening skills for doctors. On the average they interrupt their patients 18 seconds after they start to talk and often miss out on important information that maybe crucial for a correct diagnosis. As a patient I can not agree more. Patients also have a responsibility in effective communication but I think doctors have the upper hand in this matter so doctors need to read this book more carefully than patients. In my experience the doctors' interruptions can sometimes be very rude : several years ago I went to an ear, nose, throat specialist with an ear ache. After inspection he told me I had a certain kind of ear infection. I wanted to express my thoughts on the disease and said : " Doctor, as far as I know about this infection..." He abruptly interrupted and said : " Let's not deal with his infection with what you know about it but rather with what we doctors know about it ". In another case, my family and I had gone to a summer holiday village for vacation. The air temperature dropped for several days and half of the hundreds of tourists including us in the holiday resort began to cough and have fevers. I phoned the holiday camp doctor from our room and said : " Good day doctor. My family and I are coughing with a fever. Half the tourists in the resort are also. The weather is so cold. There seems to be a flu epidemic. Do you think it is a viral or bacterial infection ? " He replied : " Are you a medical expert ? I am the doctor around here and I am the best judge. I say there is no epidemic. People can get ill that is normal ".In his book Dr. Groopman, in my opinion correctly says that there is no 100 % certainty in medicine. Even the most competent doctors can make wrong diagnoses. If the frequency of mistakes is too high then we can conclude the incompetence of the doctor. This may sound like stating the obvious but Dr. Groopman further states that despite the remarkable advances in medical technology such as brain imaging techniques etc. some doctors using these can still make the wrong diagnoses not because they are incompetent but because some of them see their patients as statistics or case studies not as real human beings. They fail to understand them as human beings. Dr. Groopman talks about the wrong thinking methods here. However, as a patient I would like to add that some doctors also have bad intentions. Most doctors I dealt with were honest and helpful, but I also came across in psychiatry several who had bad intentions. I have personally seen the improper utilization of advanced knowledge and technology : in psychiatry Quantitive EEG of the brain, questionnaires filled out by the patients such as the Beck Depression Inventory, The Beck Anxiety Scale, The Obsessive Compulsive Disorder questionnaire, the Minnesota Personality Test etc. are powerful tools at the disposal of a pychiatrist to help him / her diagnose, provided that they are properly evaluated. After these tests were implemented, I understood from the very superficial and wrong comments made by the psychiatrist that he had not carefully analyzed the tests and questionnaires. He did not understand us better after those tests. It is not the tests that were wrong, they could have been very useful had he taken the time to analyze them properly. Then why did he order these tests and the QEEG ? Because the hospital charges the patients for all those tests. They make money from the tests. I would not regret paying for them had they been properly evaluated.As patients we have the responsibility to properly listen and implement our doctors' instructions such as taking the medications given in the right doses,times and durations, stop smoking and using substances, do the exercises and diet given by the doctors. But the doctors have to listen to us first. Our primary responsibility as patients is to find doctors who not only think correctly most of the time but who are also honest and competent.In his book Dr. Groopman explains how smart patients can proactively participate in their dignoses by guiding doctors' thinking with relevant questions such as " could it be anything else ? ". If the doctor feels insulted or annoyed by such questions from the patient,as was in my case, then go to another doctor until you find one who does not feel insulted by relevant patient questions. This is perhaps esspecially needed in psychiatry : there are many competent psychiatrists but many others wrongly prescribe psychiatric medication or start irrelevant psychotherapies for what turns out to be physical illnesses that mimic the symptoms of a psychiatric disorder. The irresponsible psychiatrist overlooks it because he / she does not consider the possibility of a somatic illness by ordering blood tests. In such situations Dr. Groopman's advice to patients to ask " Could it be anything else ? " to their doctors is most relevant.Thank you Dr. Jerome E Groopman for writing a much needed book. I hope many doctors and patients around the world will read it and revise their approaches towards communication with one another.

I picked up How Doctors Think by Jerome Groopman, MD as a fluke. Having accumulated more books than I can read, they gather dust on shelves or in boxes in my basement. But, around the holidays, I found myself with a gift card from Barnes & Noble, and I wandered its aisles, looking for something to grab me. It was there I spotted Dr. Groopman's book. I work in health care, in finance and have since 1988. This book a look at how physicians are trained, and how their training as well as their experience impacts the way physicians think, and diagnose their patients. Dr. Groopman put it this way. "This book is about what goes on in a doctor's mind as he or she treats a patient."(p3) The book is about cognitive errors physicians make and how patients can contribute to their physician's successful diagnosis and treatment. The author, a practicing oncologist posits comments on how healthcare economics undermines the chances of avoiding the mental errors that lead to incorrect diagnoses. (People like me get labeled "bean counter" with great aplomb. [pp90, 100, 127]) Jerome Groopman chronicles how patients access physicians, through hospital emergency rooms, primary care doctors, surgical specialists, and radiologists. During this discourse, he labels a number of thinking models, common to physicians and the intellectual errors that are linked to those models. Additionally, he spends a significant amount of time discussing how the modern practice of medicine exacerbates the conditions that may lead to misdiagnosis. Dr. Groopman repeatedly dicusses a cognitive model for diagnosing patients followed by a criticism of the model's weakness, demonstrated by a misdiagnosed patient. He criticizes the evolution of quality programs and "evidence-based medicine" programs in hospitals across the country. "Physicians should caution themselves to be not so ready to match a patient's symptoms and clinical findings against their mental templates or clinical prototypes. This is not easy. In medical school, and later during residency training, the emphasis is on learning the typical picture of a certain disorder...'Common things are common'...'When you hear hoof beats, think about horses, not zebras...Powerful forces in modern medicine discourage hunting for [zebras]." (pp126, 127)He criticizes of the economic organization of medicine, today."...deliberate analysis...requires time, perhaps the rarest commodity in a healthcare system that clocks appointments in minutes...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." (p178) This book is not a "page-turner." Dr. Groopman's examples are interesting, though they make me as a non-clinician frustrated. His attacks on evidence-based medicine can feel like an attack on those that want to reduce medical uncertainty, and their motives. His description and sometimes praise for a model of diagnosis, usually to be followed by the parallel pitfalls of that model can leave me feeling in despair. The first time I tried to read it, it was over a month long period and I had only gotten half way through the book. It just didn't compel me. When I began rereading it, I pushed through and got it completed in about one and a half weeks, skipping several days. Dr. Groopman talks about how doctors know what they know, and discusses the general environmental characteristics that lead to intellectual errors in medicine. I have seen similar forces influencing the business and industry of health care. In seminars and webinars, I see ideology, groupthink, magical thinking, fashionable nomenclature and platitudes being used as substitutes for real strategic thought and planning, then becoming conventional wisdom. Many times the tools we all learned in business school are being ignored rather than to challenge the trendy idea being proffered. It is as if business strategy has more in common with finger painting than business science. This book was worth reading! This book reminds me that these problems, paradigm lock, unwillingness to challenge authority, blindness to extraneous data are pervasive. I need to listen more, respectfully question, learn from my own errors in thinking. I have drawn value from How Doctors Think. I just had to work to get at that value.

Excellent book. Full of info that is useful. Love the book. Definitely worth reading. I even loaned my copy to a friend. The story in first chapter of how this female patient is misdiagnosed, not believed and given the run around until she sees the doctor who wrote this book. He actually listens to the patient tell her story and as a result correctly diagnosis her. Powerful book!

This seems to be a classic master piece write-up. It is a MUST reference for both patient and doctor. Very useful for business professionals too.

Dentro do esperado.

Muito bom

I have enjoyed this book very much and recommend it to every health practitioner!