|
|
How Doctors Think (Hardcover)
by Jerome Groopman
| Category:
Health |
| Market price: ¥ 268.00
MSL price:
¥ 258.00
[ Shop incentives ]
|
| Stock:
Pre-order item, lead time 3-7 weeks upon payment [ COD term does not apply to pre-order items ] |
MSL rating:
 Good for Gifts |
| MSL Pointer Review:
Dr. Groopman's latest book opens our minds to the 'heuristics' and the limitations of it, with each chapter deals with a different area of medicine and a different type of patient. |
| If you want us to help you with the right titles you're looking for, or to make reading recommendations based on your needs, please contact our consultants. |
Detail |
Author |
Description |
Excerpt |
Reviews |
|
|
|
Author: Jerome Groopman
Publisher: Houghton Mifflin Company
Pub. in: March, 2007
ISBN: 0618610030
Pages: 320
Measurements: 9 x 6.1 x 1.3 inches
Origin of product: USA
Order code: BA00808
Other information: 1 edition
ISBN-13: 978-0618610037
|
|
Rate this product:
|
|
- MSL Picks -
"Patients and their loved ones swim together with physicians in a sea of feelings. Each needs to keep an eye on a neutral shore where flags are planted to warn of perilous emotional currents". - Jerome Groopman
In this wildly important book, you learn:
- How to know what to look for in a doctor.
- How to interact with a doctor
- How to know when the doctor doesn't know
- How to know when to walk out, and go elsewhere
- How to partner with your doctor, and most importantly
- How to be your own best advisor in medical matters
This alarming statistic introduces Dr. Jerome Groopman's compelling analysis of how doctors think - and what this means for patients seeking diagnoses. Groopman is curious to discover how one doctor misses a diagnosis which another doctor gets. Interviewing specialists in different fields, he analyzes the ways they approach patients, how they gather information, how much they may credit or discredit the previous medical histories and diagnoses of these patients, how they deal with symptoms which may not fit a particular diagnosis, and how they arrive at a final diagnosis. Throughout, he considers the doctors' time constraints, the pressures on them to see a certain number of patients each day, the limitations on tests which are imposed by insurance companies or by hospitals themselves, and the many options for treating a single disease.
Most of us will be left with more respect for the art of medicine, and the careful consideration Groopman's doctors give to their patients. How Doctors Think is a book every patient needs to read. We, the patients have much more power than we know, and we can change the shape of the physician/patient relationship. We need to come to the doctor's office prepared to ask the right questions so that our physician's thought processes will be beneficial to both of us.
(From quoting Mary Whipple, USA)
Target readers:
General readers
|
|
- Better with -
Better with
The Mindbody Prescription: Healing the Body, Healing the Pain
:
|
|
Customers who bought this product also bought:
 |
The Mindbody Prescription: Healing the Body, Healing the Pain (Paperback)
by John E. Sarno
This is a great book for illuminating how our perception of stressful events - worrying, trauma, negativity, anger - manifests itself in chronic, acute pain in the body. |
 |
Healthy Aging: A Lifelong Guide to Your Physical and Spiritual Well-Being (Hardcover)
by Andrew Weil, M.D.
A must read for the average person who is trying to gain insight on healthy living from diet, herbal supplements, stress reduction and exercise. |
 |
Younger Next Year: A Guide to Living Like 50 Until You're 80 and Beyond (Hardcover)
by Chris Crowley, Henry S. Lodge, M.D.
A health-and- fitness must-read written with men in mind, but good for both men and women. A good gift to friends and family. |
 |
Body for Life: 12 Weeks to Mental and Physical Strength (Hardcover)
by Bill Phillips
With specific weight, aerobic, and eating plan that is easy to follow, this fitness classic is an inspirational guide to your personal wellbeing. |
|
|
Jerome Groopman, M.D., holds the Dina and Raphael Recanati Chair of Medicine at Harvard Medical School and is chief of experimental medicine at Beth Israel Deaconess Medical Center in Boston. He has published more than 150 scientific articles. He is also a staff writer at The New Yorker and has written editorials on policy issues for the New Republic, the Washington Post, and the New York Times.
|
|
From the publisher
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.
|
INTRODUCTION
Anne Dodge had lost count of all the doctors she had seen over the past fifteen years. She guessed it was close to thirty. Now, two days after Christmas 2004, on a surprisingly mild morning, she was driving again into Boston to see yet another physician. Her primary care doctor had opposed the trip, arguing that Anne's problems were so long-standing and so well defined that this consultation would be useless. But her boyfriend had stubbornly insisted. Anne told herself the visit would mollify her boyfriend and she would be back home by midday.
Anne is in her thirties, with sandy brown hair and soft blue eyes. She grew up in a small town in Massachusetts, one of four sisters. No one had had an illness like hers. Around age twenty, she found that food did not agree with her. After a meal, she would feel as if a hand were gripping her stomach and twisting it. The nausea and pain were so intense that occasionally she vomited. Her family doctor examined her and found nothing wrong. He gave her antacids. But the symptoms continued. Anne lost her appetite and had to force herself to eat; then she'd feel sick and quietly retreat to the bathroom to regurgitate. Her general practitioner suspected what was wrong, but to be sure he referred her to a psychiatrist, and the diagnosis was made: anorexia nervosa with bulimia, a disorder marked by
vomiting and an aversion to food. If the condition was not corrected, she could starve to death.
Over the years, Anne had seen many internists for her primary care before settling on her current one, a woman whose practice was devoted to patients with eating disorders. Anne was also evaluated by numerous specialists: endocrinologists, orthopedists, hematologists, infectious disease doctors, and, of course, psychologists and psychiatrists. She had been treated with four different antidepressants and had undergone weekly talk therapy. Nutritionists closely monitored her daily caloric intake.
But Anne's health continued to deteriorate, and the past twelve months had been the most miserable of her life. Her red blood cell count and platelets had dropped to perilous levels. A bone marrow biopsy showed very few developing cells. The two hematologists Anne had consulted attributed the low blood counts to her nutritional deficiency. Anne also had severe osteoporosis. One endocrinologist said her bones were like those of a woman in her eighties, from a lack of vitamin D and calcium. An orthopedist diagnosed a hairline fracture of the metatarsal bone of her foot. There were also signs that her immune system was failing; she suffered a series of infections, including meningitis. She was hospitalized four times in 2004 in a mental health facility so she could try to gain weight under supervision.
To restore her system, her internist had told Anne to consume three thousand calories a day, mostly in easily digested carbohydrates like cereals and pasta. But the more Anne ate, the worse she felt. Not only was she seized by intense nausea and the urge to vomit, but recently she had severe intestinal cramps and diarrhea. Her doctor said she had developed irritable bowel syndrome, a disorder associated with psychological stress. By December, Anne's weight dropped to eighty-two pounds. Although she said she was forcing down close to three thousand calories, her internist and her psychiatrist took the steady loss of weight as a sure sign that Anne was not telling the truth.
That day Anne was seeing Dr. Myron Falchuk, a gastroenterologist. Falchuk had already gotten her medical records, and her internist had told him that Anne's irritable bowel syndrome was yet another manifestation of her deteriorating mental health. Falchuk heard in the doctor's recitation of the case the implicit message that his role was to examine Anne's abdomen, which had been poked and prodded many times by many physicians, and to reassure her that irritable bowel syndrome, while uncomfortable and annoying, should be treated as the internist had recommended, with an appropriate diet and tranquilizers. But that is exactly what Falchuk did not do. Instead, he began to question, and listen, and observe, and then to think differently about Anne's case. And by doing so, he saved her life, because for fifteen years a key aspect of her illness had been missed.
This book is about what goes on in a doctor's mind as he or she treats a patient. The idea for it came to me unexpectedly, on a September morning three years ago while I was on rounds with a group of interns, residents, and medical students. I was the attending physician on "general medicine," meaning that it was my responsibility to guide this team of trainees in its care of patients with a wide variety of clinical problems, not just those in my own specialties of blood diseases, cancer, and AIDS. There were patients on our ward with pneumonia, diabetes, and other common ailments, but there were also some with symptoms that did not readily suggest a diagnosis, or with maladies for which there was a range of possible treatments, where no one therapy was clearly superior to the others.
I like to conduct rounds in a traditional way. One member of the team first presents the salient aspects of the case and then we move as a group to the bedside, where we talk to the patient and examine him. The team then returns to the conference room to discuss the problem. I follow a Socratic method in the discussion, encouraging the students and residents to challenge each other, and challenge me, with their ideas. But at the end of rounds on that September morning I found myself feeling disturbed. I was concerned about the lack of give-and-take among the trainees, but even more I was disappointed with myself as their teacher. I concluded that these very bright and very affable medical students, interns, and residents all too often failed to question cogently or listen carefully or observe keenly. They were not thinking deeply about their patients' problems. Something was profoundly wrong with the way they were learning to solve clinical puzzles and care for people.
You hear this kind of criticism - that each new generation of young doctors is not as insightful or competent as its forebears - regularly among older physicians, often couched like this: "When I was in training thirty years ago, there was real rigor and we had to know our stuff. Nowadays, well..." These wistful, aging doctors speak as if some magic that had transformed them into consummate clinicians has disappeared. I suspect each older generation carries with it the notion that its time and place, seen through the distorting lens of nostalgia, were superior to those of today. Until recently, I confess, I shared that nostalgic sensibility. But on
reflection I saw that there also were major flaws in my own medical training.
What distinguished my learning from the learning of my young trainees was
the nature of the deficiency, the type of flaw.
My generation was never explicitly taught how to think as clinicians. We learned medicine catch-as-catch-can. Trainees observed senior physicians the way apprentices observed master craftsmen in a medieval guild, and somehow the novices were supposed to assimilate their elders' approach to diagnosis and treatment. Rarely did an attending physician actually explain the mental steps that led him to his decisions. Over the past few years, there has been a sharp reaction against this catch-as-catch-can approach. To establish a more organized structure, medical students and residents are being taught to follow preset algorithms and
practice guidelines in the form of decision trees. This method is also being touted by certain administrators to senior staff in many hospitals in the United States and Europe. Insurance companies have found it particularly attractive in deciding whether to approve the use of certain diagnostic tests or treatments.
The trunk of the clinical decision tree is a patient's major symptom or laboratory result, contained within a box. Arrows branch from the first box to other boxes. For example, a common symptom like "sore throat" would begin the algorithm, followed by a series of branches with "yes" or "no" questions about associated symptoms. Is there a fever or not? Are swollen lymph nodes associated with the sore throat? Have other family members suffered from this symptom? Similarly, a laboratory test like a throat culture for bacteria would appear farther down the trunk of the tree, with branches based on "yes" or "no" answers to the results of the culture. Ultimately, following the branches to the end should lead to the correct diagnosis and therapy.
|
|
| View all 6 comments |
Robert (MSL quote), USA
<2007-06-04 00:00>
How Doctors Think is an interesting book about the medical field. I was drawn to the title, because my health is so important to me. I learned that the way a doctor communicates with a patient about medication or a problem is very important. In one study Groopman cited in this book, 45 doctors caring for 909 patients did not tell the patient how long to take a new medication or what side effects it might cause. Nearly half of the doctors failed to specify the dose and duration of the medication. This is because doctors are in hurry to see as many patients as they can.
Doctors look for symptoms when a patient is sick. They can make the mistake of focusing solely on one medical possiblity while overlooking others. This is called the error of anchoring. Groopman also talks about why doctors are uncertain sometimes. I found out that doctors are uncertain in making decisions because of limitations of current medical knowledge and incomplete mastery of available knowledge. Doctors are not gods, and they don't always have all the answers. The chapter in which Groopman talks about his friend and her faith in God. This chapter is very touching. Her adopted infant daughter from Vietnam is incorrectly diagnosed with pneumonia and other medical problems. Groopman devotes another entire chapter on the subject of how aggressively new medications are being marketed to doctors. These companies offer doctors free gifts and trips just to get the doctor to use the product on their patients.
I also learned that the way a doctor phrases his response to a patient is important. If a doctor phrases a response in a positive manner using percentage increase of improvement instead of just ramdom numbers, the patient will feel better about treatment. Groopman encourages patients to ask questions of their physician like "What else can it be?" Upon listening to a patient ask that question, a doctor will investigate deeper to find the cause of the patient's problem. This is a fascinating honest book about how doctors really think. I have a greater appreciation of the difficult job they have after reading this book. |
Susan Boswell (MSL quote), USA
<2007-06-04 00:00>
First of all, I applaud and admire Dr. Groopman's honesty and the admission that doctors are fallible. Although this book is dedicated to helping patients communicate with doctors by helping them understand how doctors think, it appears to focus more on helping physicians avoid diagnostic mistakes by reminding them of the consequences of short sighted and odds-based reasoning. This book offers numerous case study examples showing the consequences of physicians' focusing only on symptoms that fit their preconceived diagnosis rather than truly listening to the patient and asking smart questions to get more information from the patient. Dr. Groopman writes that miscommunication leads to misdiagnosis but does not really outline a method to help patients communicate better with their doctors.
I think a major benefit of this book to patients is that it will encourage them to speak up and to seek out other physicians for help if they do not receive the help they need from their physician. Dr. Groopman has indeed written a book describing how doctors think that will help patients understand doctors better. That's half the information that patients need. The other half is contained in a book written by Jane Williams. That book, Patient Self-Help Guide: How to Talk to Your Doctor contains the rest of the information that patients need to communicate with doctors. Ms. Williams agrees with Dr. Groopman that miscommunication leads to misdiagnosis and covers this at the beginning of her book. However, she teaches patients how to accurately and quickly describe their symptoms to help the physicians make accurate diagnoses the first time and avoid the diagnostic problems outlined in Dr. Groopman's book, and does so in plain language that the average patient can easily understand.
I own both of these books and have found them to be very good books with each having different but beneficial information. The two books together make an outstanding patient resource. Perhaps these two authors should consider a collaborative effort, since their works are so complimentary. |
A reader (MSL quote), USA
<2007-06-04 00:00>
How Doctors Think is thoughtful reading for doctors and patience alike. Patients, by the very nature of their dis-eased state, at often ill-at-ease with doctors. Doctors, by the very nature of their training and their task, often put their task of diagnosis above their task of listening.
Jerome Groopman, a doctor himself, reminds doctors and patients alike that the best medicine is the medicine of mutual respect, communication, and cooperation. When patients honestly speak and doctors honestly listen, then accurate diagnosis is most likely. Medicine really is about people.
Well written and interspersed with copious narrative, this is not a stereotypical technical book about a technical field. Rather, How Doctors Think provides real life stories about life and death decision-making. |
Dr Robert D. Hoffman, Family Physician, Israel
<2007-06-04 00:00>
A very thought provoking book about how doctors work and interact with patients. Although some of the situations are very familiar to physicians, the analysis of the doctor's workplace is interesting and may be very helpful for patients and family. We can all benefit from more involved patients, and it can be very important to empower patients to challenge the doctors' decisions. I always recommmend my patients ask other doctors "Do I have to take this medicine or do this test?" in order to allow the doctor to think again, and possibly to discuss the pros and cons with the patient. A very worthwhile read. |
View all 6 comments |
|
|
|
|
