How Doctors Think

I enjoy Groopman's articles in the New Yorker, and I took this selection after hearing his compelling interview on NPR. However, I was disappointed in the content of the book. This does not really tell us too much about how doctors think; what constitutes the complexity of a diagnosis or how doctors make decisions. Rather, it is more of a collection of stories about misdiagnosis or mistreatment of patients and friends of Dr. Groopman. And it turns out that Groopman is mostly the hero of the book -- either making the tough diagnosis himself or referring to one of his friends who saves the day. His friends happen to be located at Harvard, Mayo Clinic, and Sloan-Kettering. Not exactly the answer for the masses of Americans belonging to HMOs who cannot even get a specialty referral without a letter to a congressman.

The book starts out addressing the theme that young doctors are becoming too entranced with algorithmic medicine. He complains that they follow guidelines for care like robots on an assembly line. Most would agree, however, that the bigger problem in American medical care is the failure of doctors to adhere to evidence-based guidelines, rather than over-reliance on them. Care for diabetics, asthmatics, and hypertensives fall far short of what it should be and what would improve the health of the nation.

Dr. Groopman does share our pain, however. He had a day of distress because a doctor called him at home with a fatal mis-diagnosis while his wife was away skiing. He had the diagnosis corrected the next day at work, but lost a night's sleep over it.

Once you get past the self-congratulations, the old-boy network of super-docs, the confessions of imperfection in himself, and the self-pity; there are a few good points.
1. Get a second opinion.
2. Be an informed consumer.
3. Ask questions
3. If you do not like your doctor, get another one.
Not worth the read to learn these lessons.;

This book provides a fascinating insight into medical decision making in the absence of hard evidence and lives at stake. At the end of the book, I definitely had a much better feel for what doctors could reasonably know when making diagnoses and decide on treatment and how difficult it must be to recommend paths forward for medical interventions. One thing I definitely took away from this book is that doctors are not all-knowing and when in doubt, do get a second opinion even if it is just to get a sense of how differing opinions about a certain condition really are...
Great book, I have already recommended it to many of my friends and colleages as a "must read".

Any health-care provider will greatly benefit from reading and applying the gems in this book. As a result, so will our patients. It is excellent in its science, its logic and its writing.

I really enjoy Jerome Groopman's columns in the New Yorker, but the book made him seem stiff, repetitive, and pompous. All the observations seemed trite and obvious and none of his case studies held my interest for their length. Even worse, the reader read everything in a flat monotone, reminiscent of a 1950s educational tape (e.g., "Your Friend, Aluminum"). Do not attempt this book while driving -- your mind will wander and you will fall asleep.

The best parts of the book are Groopman's discussing his own (rather than other doctors') experiences; particularly interesting was his description of his article on Cox-2 inhibitors, which kicked off much of the enthusiasm for those drugs in the US.

To begin with, the narration was horrible. I am a doctor and had looked forward to this book with great enthusiasm. However the narrator's dry, business-like narration sounded like the worst stereotype of a condescending paternalistic doctor one could imagine. But to make things worse he frequently and repeatedly mispronounced medical terms. How hard would it have been to make a list of terms he did not recognize and ask Groopman how to say them?

As far as the book goes, it was generally excellent, and I have found it very instrumental in guiding my own thinking and avoiding mistakes. There were some sections that were silly, for example there is a section in which his fellow temple congregant, a mother named Rachel, underwent an ordeal in which a child she adopted got very sick. He spent way too much time on this chapter and focused, nearly obsessively, on her religious reflections which did nothing to advance the points he was making.
At other times he was repetitious. For the most part, however, this was an exhilarating and a refreshing way to look at medical errors and medical decision making, and is getting the attention it more than deserves from medical circles.

Doctors are human, just like us. And if you care about your health and want to get good health care results, it pays to remember this. The book is interesting and informative, with fascinating anecdotes, and provides useful insight, looking through the eyes of doctors.

reminiscent of the work of the great surgeon Richard Selzer, Groopman's work gives the reader a wonderful insight into the ways that a doctor thinks, both when he makes the right decision regarding a patient--and when he makes a wrong one. He reminds us of what real critical thinking is--being at once calculating and creative in a realm in which uncertainty reigns.

Really boring and mistaken in many assumptions. Its not that doctors don't think of an unusual disease (such as Wilson's disease) every time a drunk enters the ER, its that payers will not approve exotic tests on every patient. We could practice medicine to never miss a diagnosis but at a staggering cost that society is not willing to pay for. Any episode of "House" is a better insight into how doctors think.

Not hard to put down. Frankly I did not even finish it.

A great book for everyone to read as it illustrates, as the author states, that a patient has to be an active participant in the process of seeking the care and treatment one needs.