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How Doctors Think

2007 non-fiction book by Jerome Groopman

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Without risking failure there is zero chance of success

  • Apr 20, 2009
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When Dr. Jerome Groopman began his medical internship at the Massachusetts General Hospital, he placed a high priority on facts. While in medical school he had tirelessly tried to "store an encyclopedia in [his] mind" as so that when faced with patients, he could "open the mental book and find the correct diagnosis and treatment." Thirty years later he saw students and residents relying on statistics, algorithms, "evidence-based" guidelines -- tools he feared would shackle their cognitive processes. How do doctors think, he wondered? How SHOULD they think?

This book is the product of his thoughtful consideration of those questions. He read the available research and spoke with many colleagues about their theory and experience, assembling cases to illustrate his findings. There are many ways a doctor can fall into errors of cognitive process. Representativeness error matches the patient against a prototype and fails to consider other possibilities: a fit, active man is probably not having a heart attack. Attribution error leads a doctor to categorize the patient negatively: the disheveled patient with edema and an enlarged liver is probably an alcoholic. Affective error prevents the doctor from looking beyond favorable indicators for a liked or admired patient. These and other errors are based in social assumptions and pattern recognition, and in the general rule that when you hear hoofbeats, you should think of horses, not zebras. In these days of managed medicine, there is bias toward a linear approach and "satisfaction of search" -- settling for the first answer that reasonably accommodates the available data.

The detailing of these and other cognitive errors and shortcuts actually forms a small part of How Doctors Think. Dr. Groopman goes on to discuss situations where errors of thinking are likely to occur: the reading of X-rays and CT scans, the impact of marketing on medical decision making, the roles of variability and uncertainty in treating babies with malformed hearts, the treatment of cancer. The patients and their stories are well integrated with Dr. Groopman's discussion of his subject: how to partner with the patient for the best possible outcome.

This is not a book of medical horror stories, nor of doctor-bashing; not even of managed care-bashing. It's a measured exploration of the doctor's role, with a final chapter offering advice to patients on questions they might ask their doctors. Required reading for all parties in the health care team. Yes, that means you!

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review by . December 07, 2008
How Doctors Think
They say that knowledge is power.  Every so often a book comes along that substantially improves the chances of a person successfully navigating an unfamiliar or stressful situation.  One such book is Dr. Jerome Groopman's latest offering "How Doctor's Think".  This is a book written by a physician that is intended for general audiences.  The good doctor has done us all a real service here.      For the average person a sudden dibilitating …
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About this book


On average, a physician will interrupt a patient describing her symptoms within eighteen 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. Groopman 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 profoundly impact our health. This book is the first to describe in detail the warning signs of erroneous medical thinking and reveal how new technologies may actually hinder accurate diagnoses. How Doctors Think offers direct, intelligent questions patients can ask their doctors to help them get back on track.

Groopman draws on a wealth of research, extensive interviews with some of the country’s best doctors, and his own experiences as a doctor and as a 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 twenty-first-century medical practice, giving doctors and patients the vital information they need to make better judgments together.

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ISBN-10: 0618610030 (hbk.)
ISBN-13: 9780618610037 (hbk.)
Author: Jerome Groopman
Genre: Science, Medicine, Physician & Patient
Publisher: Houghton Miflin
Date Published: March 19, 2007
Format: Hardcover
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