A Book About How Doctors Think: “How Doctors Think” by Jerome Groopman

I just read an interesting book review in the New York Times (Friday, March 23, 2007, page B28)- the review was written by William Grimes and it is available at nytimes.com/books. Dr. Groopman is a professor of medicine at Harvard Medical School and I know he has written articles for the New Yorker for a number of years. Anyway, based on the review I intend to read the book.
I’ve always wanted to know how doctors think. Actually, the thought process that goes into medical diagnosis and treatment is not all that well-understood and defies computer modeling. You’d think one could design a computer program to provide diagnostic possibilities given a set of signs, symptoms, and laboratory test results. The problem has been that just generating a computer list of possible diagnoses, perhaps with statistical probabilities, does not work nearly as well as an intelligent and knowledgeable physician who has the time and interest to “sort things out.” Just having a long list of possible diagnoses based on the computer input, doesn’t get one much closer to diagnosis and treatment. Where computers help is in making one aware of drug incompatibilities, side effects, etc., that might be of great importance once a diagnosis is made and treatment planned.

Of course, most of medicine is quite pedestrian; whether we are generalists or specialists; most of what we see is the same thing over and over again, maybe with a few twists here and there. The really good doc can somehow tell when a problem may not be so run-of-the-mill. In my experience, the best physicians look at diagnosis and therapy as steps to the best possible outcome, whatever the problem. The “steps” are careful follow-up with a willingness to rethink the problem at any point along the way if the pieces are not fitting together as they should. No one is perfect, and we all make mistakes; we can only hope that we do not make many mistakes and that we learn well from each one.

It’s hard now that we have so many fancy diagnostic tests available; there may the temptation to order many expensive tests to make a diagnosis without thinking things through carefully. I have noticed that many younger physicians (I won’t define what I mean by “younger”) jump to diagnostic testing even before they have obtained key information from the history and physical examination. Some also order a “battery” of tests when they could start with just a few key tests and see what the results show. I’m not talking about a medical emergency where one might have to act quickly and ask questions later (what’s that old joke about “ready, fire, aim?”).

Anyway, I looking forward to reading Dr. Groopman’s book. Maybe it will make me smarter?

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