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Type of bind: Paperback
Dewey Decimal Number: 610
EAN num: 9780547053646
ISBN number: 0547053649
Label: Mariner Books
Manufacturer: Mariner Books
Quantity: 1
Page Count: 336
Printing Date: March 12, 2008
Publishing house: Mariner Books
Sale Popularity Level: 812
Studio: Mariner Books
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How Doctors Think is a window into the mind of the physician and an insightful examination of the all-important relationship between doctors and their patients. In this myth-shattering work, Jerome Groopman explores the forces and thought processes behind the decisions doctors make. He pinpints why doctors succeed and why they err. Most important, Groopman shows when and how doctors can -- with our help -- avoid snap judgments, embrace uncertainty, communicate effectively, and deploy other skills that can profoundly impact our health.
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Rated by buyers 
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The most powerful messages I got from reading Groopman's How Doctors Think are related to his positions on treatment algorithms and practice guidelines and health care quality.
While many medical professionals consider evidence-based medicine the gold standard of medical practice, Groopman expressed his concern about the detrimental effect it has on doctors' ability to think independently and creatively. He reasoned that strictly adhering to algorithms debilitates doctors' ability to think outside the boxes and limit them from taking into consideration the idiosyncrasy of each individual patient.
Groopman also argued that "quality in primary care means much more than using metrics to judge a physician's quality or keeping a scorecard to ensure blood sugar was messaged and a flu shot given." He gave quality of care a new definition: "Quality means thinking broadly, because any and every problem of human biology can present itself; it means making judicious decisions with limited data about children and adults, neither overreacting nor being blasé; it means wielding one's words with precision and with a profound appreciation of the social context of the patients. It means, as a gatekeeper, knowing where to guide us. One of those portals opens to the intensive care unit."
After reading Groopman's viewpoints on evidence-based medicine and quality of care, I can't stop wondering whether the "Pay-for-Performance" program which offers physicians financial incentive for providing "quality of care" based on predefined quality measure target(s) that are in alignment with certain evidence-based clinical guidelines is the direction our nation should follow.
It is disconcerting to find that our current health care reimbursement structure is the hidden cause of some of these cognitive errors. In an era of managed care, many physicians are stretched thin and burned out. They are pushed to see more patients in shorter duration. Under time constraint, physicians are forced to make snap judgment. It is inevitable that they commit cognitive errors or biases (from representative, affective, availability and satisfaction of search error, to confirmation, anchoring and commission bias) because of the time pressure. The cost-driven system also forces them to make decisions based on cost control rather than the best interest of the patients. The fee-for-service payment mechanism reimburses physicians better for procedure rather than consultation, so they will prescribe unnecessary procedure to increase revenue.
Among the many stories in the book that have left lasting impressions on my mind, the one that struck me the most is his narration of his very first patient encounter thirty years old on his very first day of internship at the Massachusetts General Hospital. He described himself as an intense, driven student carrying a pack of index cards from medical school in his pocket. During his very first encounter of emergency medicine in the "real world," he faced a hypertensive patient with a tear through his aortic valve. He tried to think (and response) but couldn't. He was stunted and paralyzed. In this critical moment when it required his "flesh-and-blood decision-making," he failed to make a prompt response. This reality check taught him that his high grades in medical school were meaningless. The index cards in his pockets were just dead weight. It may be hard to believe, but even people who are highly intelligent (and full of confidence) may have difficulty making prompt decision in split second.
Another story that is as intriguing is the incident in which he failed to ask him to roll over so he could examine his buttocks and rectum simply because he felt for his patient and didn't want to cause him extra suffering. He thought he should have examined him more thoroughly and he berated himself for doing a sloppy job. He learned that "physicians must learn to suppress their emotions, to block their natural reactions to many of the awful things they see and the brutal thing they must do to their patients. They have to detach themselves from anguish that could impede their work." It is important to note how our emotion may impede our work performance.
I highly recommend this book to medical students, residents and medical professionals, who will find in this book many invaluable lessons on how to avoid cognitive errors and biases. I will recommend this book to patients, their families and friends, who will find in this book many helpful tips on helping their physicians avoid cognitive pitfalls.
Rated by buyers -
I am an R.N., and thought I knew how my fellow medical people, the doctors, thought. They acted in unusual ways at times, but I didn't know why. This book is a portal into the ways that the people who hold our lives in their hands, come to some of the decisions that they make. I recommend it highly to all. You don't have to be in it (the medical profession) to be aware. At some time, sooner or later, we and our families and friends become ill. At that time, we all need doctors. It is good to know a little more of their training, and what might make them tick in a certain way. It is well-written, and makes many valid points.
Rated by buyers 
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As a clinician in the aftermath of making a cognitive error, I found Dr. Groopman's book inspiring. It has opened my eyes to blind spots in thinking and how emotions play a bigger part than we want to admit. Reading this book has given me insight about how the very things that are strengths if taken to the enth degree can be a weakness.
This book is relevant not only for the clinician who wants to improve, but for patients who want to learn how to best communicate their needs in a way that gets the attention and focus of the clinician from the moment they say enter into that delicate relationship and allow a stranger to examine their most intimate selves.
Rated by buyers -
Excellent book: Sharp, clear, and easy to read.
One of these books that do not last on the shelf because there is always someone reading it in the family or among your friends.
Rated by buyers -
Dr. Groopman's insightful book provides valuable insights into the process by which an individual becomes a mature physician and learns to think like one. In today's world, that necessitates rapid turnover of patients and thought processes dictated by medical guidelines and payment schedules which discourage creativity and out-of-the-box thinking. This incisive work provides insights into the thought processes of physicians in making a diagnosis, and how physicians learn to think in that manner. The material is both interesting and pragmatically important for everyone who utilizes physicians and those who should. I found this book invaluable, since I am both a physician and one of those individuals who almost died due to misdiagnosis.
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