How Doctors Think [Paperback]

This book, despite one or two good chapters ultimately disappoints. Groopman's ego comes across and one can almost feel his sense of superiority coming of the pages. Too much of the book is devoted to telling us about the more inane experiences in his life and he seems to have no problem in repeating the same point repeatedly. The book doesn't flow well, there seems to be little to link one chapter to the next. Whilst a generation ago this may have been one of the few books of its kind out there that is no longer the case today. The far superior books by Atul Gawande are those that people should peruse, not this over sentimentalised, rather dull book. I will make an exception for the chapter on primary care, which alone is the only part of the book worth reading. Make no mistake this book is on an important topic, doctors most of all need to examine how they think. Unfortunately is written by someone poorly literate and with few new things to say.

This alarming statistic introduces Dr. Jerome Groopman's compelling analysis of how doctors think--and what this means for patients seeking diagnoses. Groopman is curious to discover how one doctor misses a diagnosis which another doctor gets. Interviewing specialists in different fields, he analyzes the ways they approach patients, how they gather information, how much they may credit or discredit the previous medical histories and diagnoses of these patients, how they deal with symptoms which may not fit a particular diagnosis, and how they arrive at a final diagnosis.

Throughout, he considers the doctors' time constraints, the pressures on them to see a certain number of patients each day, the limitations on tests which are imposed by insurance companies or by hospitals themselves, and the many options for treating a single disease. He is sympathetic, both toward the patient and the physician, and, because he himself has had medical problems, he provides insights from his own experience to show how physicians (and patients) think.

Case histories abound, beginning with the 82-pound woman, whose celiac disease was not diagnosed for fifteen years. Here Groopman analyzes the uses and misuses of clinical decision trees and algorithms used by many doctors and hospitals to assess probabilities and make decision-making more efficient. Sometimes, however, it is necessary for a doctor to depart from the algorithm and obey intuition. Recognizing when the physician is "winging it"--depending too much on intuition and too little on evidence--is a challenge for both patients and other physicians. Ultimately, Groopman focuses on language as the key to diagnosis, showing that when patients and physicians can communicate and truly share information, they have a better chance to come to correct diagnoses and appropriate treatments.

The success of Groopman's book attests to the need for discussion of these issues, but I am not sure Groopman realizes the difficulty patients have in finding ideal doctors whose personalities, thinking, and communication styles are compatible with their own. Most of us are referred to specialists by our primary care physicians (some of whom we see only once a year), and it is not possible to interview several specialists to find the one most suitable. We accept the appointment our primary care physician has set up for us, often with the specialist who has the earliest available appointment. Patients with urgent problems may have fewer choices than Groopman seems to think they have. Though we all search for the ideal, ultimately we must hope that our own diagnoses are not among the problem 15%. n Mary Whipple

Bought this book many years ago (sorry, late review) and after reading it, I lent it to the Medical Consultant on the ward I was a nurse on - he thought it was great, and bought 5 and gave them to his junior doctors!