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Reading 2012: How Doctors Think

September 5, 2012

Dr. Jerome Groopman’s How Doctors Think is an important read for both laymen and those involved in the medical profession. Dr. Groopman brings to this book his medical and professional expertise as current medicine and biology staff writer for The New Yorker and as the Dina and Raphael Recanati Chair of Medicine at Harvard medical school; but he also draws on his experience as a patient, as well. 

A more accurate title for the book might include, how doctors are taught to think, how doctors are probably thinking, how doctors should think, and how patients and doctors could better communicate based on typical thinking-evaluation patterns. The book is rich with anecdotes illustrating how doctors and patients think, and the hurdles that both doctors and patients must face in their attempts to communicate.

Passive-Player Patients and All-Powerful Physicians 

Although a practicing conservative Jew, Groopman’s faith really only comes into the book in one section. In it, he makes an insightful observation of how religion can sometimes influence one’s interaction with physicians, and it is also one that I’ve observed among fellow conservative American Christians, from both perspectives.

“One school of thought holds that religion makes people passive, accepting the course of events as God’s will. Such patients, these critics assert, relegate their personal responsibility for choices and actions to an imagined force outside themselves, thus further infantiliazing their part in an already overly paternalistic relationship with their physicians. This view is a corollary of Karl Marx’s famous assertion that religion “is the opium of the people,” a pacifier of both the individual and the society. For Rachel [an orthodox Jew, her story shared more in depth in the entirety of the book] it was quite the opposite: faith can make a person a productive partner in the world of medicine. Faith, a well-recognized source of solace, of strength to  endure, can also give people the courage to recognized uncertainty, acknowledge not only their own fallibility, but also their physicians’, and thereby contribute to the search for solutions.”

While Christians must often grapple with accepting their circumstances as God’s will, that by no means necessitates relegating themselves to an infantilized relationship with their physicians. I have seen this play out in various situations, but perhaps at this child-bearing stage of my life and my same-age connections, I have seen this frequently come out in the phrase “the doctor let me” or “the doctor said I had to” in relation to birth and infant care. There is likely a time and place for such phrases, but sometimes they are used to justify unnecessary medical procedures and decisions that the “patients” are unaware or unwilling to question or bring in additional information that may be helpful to the medical community.

Sometimes those phrases are then spiritualized, “Praise the Lord, the doctor let me…” or “I was so blessed that my doctor let me…,” when in reality the medical system would be blessed by more patients questioning the necessity of procedures and not having to continue the cycle of making decisions from fear of malpractice. Faith in God can, like Groopman asserts, give us strength and insight to look toward God’s immaculate design, toward both human fallibility and human advancement, and work together to find and consider multiple solutions.

In multiple cases Groopman illustrates how those who accept doctors as infallible and  all-powerful can actually perpetuate poor care and communication. At the same time, he urges doctors and patients to work together to establish a relationship of mutual trust and respect.

Better Patients and Better Doctors 

“What we say to a physician and how we say it sculpts his thinking. That includes not only our answers, but our questions.”

Sometimes patients can move from doctor to doctor complaining about the poor care or mistreatment. While there certainly is a genuine problem of corrupt medical care providers, sometimes the best way to find a better doctor is simply to learn to be a better patient. Realizing the relationship is one of working as partners together toward better health, learning to communicate together, trusting instincts and hunches, and doing research and asking informed questions will get everyone farther than if they merely accept everything without question.

The book also helps patients realize that doctors enter each case with multiple cognitive biases (even asserting “most doctors are unaware of their cognitive mistakes.”), though bias need not always be seen in a negative light. For instance, a doctor who has a deep relationship or friendship with a patient may be tempted to avoid more invasive tests or treatments because he does not wish to exacerbate a loved one’s suffering (this was actually a situation that Groopman found himself in). Another bias that may cloud a physician’s judgment is familiarity, which may often breed a contempt for alternatives. When a doctor is an expert in a very familiar condition, he may be hesitant to consider other options if all the typical symptoms are seeming to match up with his normal diagnoses. Or, a doctor may have the bias of having made a mistake on similar issue before. In reaction to that, he may actually overreact and misdiagnose when a similar issue is presented.

Busy Doctors Need Information

Groopman is also quick to note the difficulties that the modern health insurance practice can create (e.g., by only covering certain procedures, not covering “thinking time”) and the influence that pharmaceutical marketing can hold over considering various treatment options.

Whether fault of their own or their externally regulated fast-paces schedules, Groopman shares that within eighteen seconds of conversation, most doctors have already interrupted their patient and already on their way to a diagnosis and treatment plan. When this is the case, certainly the biases mentioned above and in greater depth in the book will likely play into the conclusions. This is when the patient will need to evaluate the doctors thought processes and provide information that would be helpful in working together as a team.

“A good physician learns how to manage time. Symptoms that are straightforward can be accurately defined and explained to a patient and loved ones in clear accessible language within a twenty minute visit… complicated problems cannot be solved too quickly. A discerning doctor will recognize when more time is needed to ask questions and explain his thinking..Despite all the pressures to limit time in managed care and the pursuit of putative efficiency, doctors and patients should push back. Finding the right answer often takes time. Haste makes cognitive errors.” (88)

Questions and Conclusions:

Overall, this is a helpful book, and one that will likely enhance the medical experience of whoever reads it. It will be particularly helpful to lay people, and as such, indirectly beneficial to their doctors. It will prove more directly helpful to doctors in evaluating thought processes, and, in a sense, seeing how patients think. From some parts of the book, doctors may emerge with a bruised ego. In other cases, lay people may feel overwhelmed by thinking of all the details they need to consider and study. Realistically, though, neither aspects are truly the the tone of the book.

Although my undergraduate degree (Biology) included some preparation for the medical field and I still hope to pursue academic graduate work in medicine at some point in my life, I still am still severely unqualified to read this from the perspective of a doctor (or similar medical practitioner) and would be interested in the opinions of professional physicians who may have read this book.

Table of Contents: 

 

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