My thoughts on Jerome Groopman’s How Doctors Think:
people who go to the doctor should read this book
Four years ago I went to my doctor in Massachusetts with a high fever and an earache. She diagnosed an ear infection and gave me antibiotics. Ten days later, I was in the hospital – in a room where they could turn on the negative air pressure at a moment’s notice – with malaria. If I read Groopman’s book before having that experience, I might have gotten the treatment I needed at a much earlier, safer stage.
Groopman’s book is all about why doctors get it wrong sometimes and what we can do – as patients and their loved ones – to help them get it right. Ultimately, doctors – like everyone else – are subject to a number of cognitive biases, such as availability (where they think you have whatever they’ve seen a lot of recently) or search success (where, as soon as they find a problem, they stop looking even though it could be something else). Groopman outlines these biases and illustrates each with multiple actual cases.* He then gives the reader practical advice about how to help doctors avoid these biases. For example
Patients can help the doctor think by asking questions. If he mentions a possible complication from surgery, they can ask how often it happens. If he talks about pain and lingering discomfort from a procedure, they can ask how the pain compares with having a tooth pulled under Novocain, or some other unpleasant event. If he recommends a procedure, patients can ask why, what might be found, with what probability, and, importantly, how much difference it will make to find it. (p175)
Here are a few of the other questions he recommends in the course of the book:
* What is the worst diagnosis that could explain these symptoms?
* What organs are near where I’m feeling discomfort?
* Is it possible that I have more than one problem?
* What else could it be?
* Is there anything that doesn’t fit?
* Is this treatment standard or do different specialists recommend different approaches? Why?
* How time tested is this treatment?
The book describes a litany of medical cases, each interestingly (like a good tv show – see below). Groopman also describes lots of research on medical decision making. I found it 96% interesting. But if you don’t find those elements interesting, the book may feel a little bit long.** In that case, I highly recommend reading at least the epilogue, which concentrates some – but not all – of what patients and families can ask to help doctors do a good job. I don’t agree with Groopman on everything; I have a little less faith than he does in doctors’ judgment and a little more in evidence-based medicine,*** where it can be appropriately applied. But those aren’t the things that matter in this book.
Take-away: Give the book a try; if it starts feeling long to you, at least carefully read the epilogue.
I listened to the unabridged audiobook read by Michael Prichard (9 CDs). It was a solid reading.
* The first third of the book basically felt like watching a season of House M.D., a show in which a brilliant doctor is surrounded by a smart team, each member of which brings her or his biases to the case of the episode, leading to incorrect diagnoses, until the brilliant Dr House saves the day. Each of the biases and many of the diseases have come up on the show.
** If you do find reading this stuff interesting, one of my favorite books by a doctor is Arun Gawande’s recent Better: A Surgeon’s Notes on Performance.
*** Super Crunchers makes a strong case for evidence based medicine, written for the layperson.