How Doctors Think

By: Jerome Groopman M.D.

Narrated by: Michael Prichard

Length: 10 hrs and 27 mins

Publisher's summary

A New Yorker staff writer, best-selling author, and professor at Harvard Medical School unravels the mystery of how doctors figure out the best treatments - or fail to do so. This book describes the warning signs of flawed medical thinking and offers intelligent questions patients can ask.

On average, a physician will interrupt a patient describing her symptoms within 12 seconds. In that short time, many doctors decide on the likely diagnosis and best treatment. Often, decisions made this way are correct, but at crucial moments they can also be wrong - with catastrophic consequences.

In this myth-shattering book, Jerome Groopman pinpoints the forces and thought processes behind the decisions doctors make. He explores why doctors err and shows when and how they can, with our help, avoid snap judgments, embrace uncertainty, communicate effectively, and deploy other skills that can have a profound impact on our health.

Groopman draws on a wealth of research, extensive interviews with some of the country's best physicians, and his own experiences as a doctor and patient. He has learned many of the lessons in this book the hard way, from his own mistakes and from errors his doctors made in treating his own debilitating medical problems.

How Doctors Think reveals a profound new view of 21st-century medical practice, giving doctors and patients the vital information they need to make better judgments together.

©2007 Jerome Groopman, M.D. (P)2007 Tantor Media Inc.

Critic reviews

"A revealing, often disturbing look at what goes on in doctors' minds when treating patients....A highly pleasurable must-read. "(Kirkus)
"I wish I had read this book when I was in medical school, and I'm glad I've read it now....Every reflective doctor will learn from this book....every prospective patient will find thoughtful advice for communicating successfully." (Publishers Weekly)

Good insight to medicine but...

Not every patient has the luxury of being in a physician marriage and seeking out five highly trained specialists and a sixth specialist to review the complicated choice of treatment. This is the epitome of doctor shopping.

Not every physician who spends their whole energy through the day and past 8pm is the model clinician. Not every physician who strives for a work-life balance is a failure to her or his patients.

I appreciate the deep discussion about uncertainty in medicine, cognitive errors, biases and heuristics. Thanks.

Modestly good overall

Dr Groopman describes how doctors can be correct or incorrect in their thinking. He explains biases, how to ask questions appropriately and common pitfalls. My favorite section was when he drew on his own interactions with hand surgeons when he was a patient for physical trauma he experienced. He recounts his own problem solving to navigate the health system and visit with 4 surgeons before reaching the correct diagnosis and finally having the confidence in the level of expertise of the 5th surgeon to do the surgery. Also appreciated how he got perspective from not only doctors in various fields, but also from a woman who gets misdiagnosed and a parent who insists that her sick baby is malnourished. The audiobook narration was fine overall, but as a small detail I cringed every time he slowly spelled out E-C-M-O or M-R-S-A, as they are most often pronounced "ehk-moh" and "mer-sa" by healthcare personnel. This book was highly recommended twice to me so I thought I would have a glowing review, but I would only modestly recommend.

Disappointing

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.;

Terrible narration, great idea, good execution

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.

excellent on all counts

Excellent book, wonderfully read! I held my breath for 5 whole minutes during the somewhat harrowing central story. Who'da thunk it for a book about how doctors make decisions and what they think of patients?

Odd narration, good book

Is there anything you would change about this book?

I thought the writing was good and the content was very interesting. Many of the cognitive issues addressed apply to areas of life other than medicine, so I think I will be able to apply some of the lessons from this book, even though I am not a doctor. It will probably make me a better patient, too.

What didn’t you like about Michael Prichard’s performance?

His voice sounded like a 1950's TV doctor. It was a bit jarring at first, especially in contrast to the content of the book. If I revisit this book, I will probably switch to reading it, rather than listening.

insightful for a medical student

Thoroughly enjoyed listening to the thought process. I may recommend this to patients as a glimpse into the mind of physicians. author does a great job of clarify technical medical terms. The jargon may be overwhelming at times, but the point is usually clear. Strongly recommend individuals who have questions about the general approach of physicians to read or listen to this book.

Run of the Mill

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

disappointing

Disappointing......the part about Rachael and the baby from Vietnam seemed to go on forever leading nowhere.

Dated---couldn't finish

Great premise. Narrator was totally a throw back from the 50's. Combined with the masculine pronouns for the M.D., I had the impression that this was not current enough to represent how drs think now or the progression that may be needed.. I believe the idea is still valid but needs overhaul.