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Tuesday, April 17, 2007

How Doctors Think

After a few weeks in the Minuteman Library Network queue, Jerome Groopman’s recently published book, How Doctors Think, finally became available, so I promptly checked it out and checked it out. It lives up to its publicity, though the brief reviews and interviews are (unsurprisingly) in some ways misleading. Yes, Dr. Groopman does tell us about doctors usually make snap judgments and how they make mistakes in their thinking. That much is true...and valuable. But focusing on this idea greatly oversimplifies a more complex book. The title suggests a lot more than snap judgments and mistakes. It doesn’t say “How Doctors Think Incorrectly,” but — more simply and more comprehensively — “How Doctors Think.” And that’s what we learn.

Of course it’s more sensational to focus on medical mistakes. The doctor who reaches a judgment in ten seconds rather than ten minutes can be alarming — and even ten minutes seems far too short. What especially interests me as a math teacher is that the two most common mistakes that Groopman discusses are the same as my math students’ two most common mistakes: they want a really quick answer rather than think about a problem in depth, and they want an algorithm they can follow rather than think about each problem individually. Surely it’s no coincidence that doctors and math students fall into the same trap. Groopman tells plenty of true anecdotes about medical errors of both of these types. Like any good story-teller, he writes about concrete examples, involving himself wherever possible, rather than using impersonal, “scientific,” third-person examples. These anecdotes are successful in bringing Groopman’s ideas to life without overwhelming the reader with too many examples.

Doctors are understandably reluctant to criticize each other. Groopman cites plenty of instances of poor judgment, though never by name, and plenty more instances of excellent judgment and devoted care, naming names in those cases. As an oncologist, Groopman is particularly moving in his long exposition of cancer cases in friends, acquaintances, and strangers, where we learn of the many alternatives that physicians have to consider and how they think about those alternatives.

We all need medical care, and we all want to trust our doctors. But we need to be our own best advocates. In some ways this highly readable book will scare you, but in other ways it will give you a glimpse into the mind of the doctor and will help you advocate for yourself.

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