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>How Doctors Think

Bryce Templeton, M.D., M.Ed.

How Doctor’s Think is a loosely-organized but very readable account of a variety of medical and surgical diagnostic conundrums, and Groopman’s stated goal is to show laymen how physicians think—with the expectation that, with such knowledge, patients may be able to minimize all-too-frequent diagnostic errors. He includes a substantial number of well-written clinical vignettes, some brief and some quite long.

For example, Groopman’s first chapter-long account concerns a woman in her 30s who struggled for 15 years with treatment-resistant weight loss. She counted calories to maintain her weight, saw many different specialists, and was hospitalized several times for weight loss, with a diagnosis of anorexia nervosa. After almost 15 years of illness, the patient’s boyfriend insisted that she see one more gastroenterologist. The latter listened to her very carefully, correctly concluded she might have sprue, and initiated confirmatory studies. Although Groopman assigns credit to the clinician’s careful attention to the patient’s story, the clinician happened to have had NIH research experience with malabsorption problems. Thus, the successful outcome for this patient could be attributed to her boyfriend’s insistence on one more evaluation and the latter’s luck in unknowingly selecting a consultant who happened to have especially relevant, disorder-specific experience.

Groopman briefly touches on a variety of other topics: the waning use of autopsies, the need for caution in too-heavy a reliance on evidence-based medicine, the dangers of stereotypical thinking, various cognitive traps (the latter not well explained), the adverse effect of physician fatigue, and physicians’ handling of errors in patient care. He stresses and illustrates the value of considering, with each patient "What’s the worst thing this can be?" and the necessity of considering a few alternative diagnoses, even with problems of a seemingly obvious nature. His most systematic discussion concerns radiologists’ methods of reviewing film findings in ways that may either increase or decrease errors in observation and diagnosis.

Many readers will recognize Groopman as the author of three other very popular books about medical practice, The Measure of Our Days, Second Opinions, and, in 2002, Anatomy of Hope. Groopman confesses that for many years he stuck pretty closely to a biomedical model. Then, in part on the basis of some of his own medical problems, he became aware of addi[eltionally important elements in patient care, but not quite a biopsychosocial approach.

I do not believe that Groopman’s goal—helping patients to help doctors avoid errors—was met. Nevertheless, he is a good story-teller, providing insightful details about patients and their clinical problems; and often about the respective clinicians and their approaches to patient care.

FOOTNOTES

 
Dr. Templeton is Professor of Psychiatry and Associate Director of Undergraduate Medical Education in Psychiatry, Drexel University College of Medicine.

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