August 2, 2007


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How Doctors Think, by Jerome Groopman, MD (Houghton Mifflin, 2007, 320 pages)
Reviewed by Eric W. Saeger

We live in a world increasingly made more dangerous by overcaffeinated rubber-stamped experts wielding bull-headed absolutes and drive-through philosophy. Dr. Jerome Groopman’s excavation into the thinking processes of his peers is a marginally useful study brought about by his obviously gregarious nature, full of info that will undoubtedly serve to reassure patients and other medical industry outsiders that they’re not automatically incorrect about what’s causing particular symptoms simply because they don’t hold medical degrees.

Using casual case-by-case analyses, Groopman exposes the usual suspects that are present when a patient’s problems don’t go away. The first and most common roadblock is the rote diagnostic algorithms toward which most MDs gravitate, learned not only from their professors but more often through experience. The more close-minded a doctor is, the more they’ll tend to tell you nothing’s wrong with you when it’s patently obvious there is. Also discussed in these chapters is the fact that there are a lot of doctors who don’t listen or know how to interrogate patients, pointing to a fundamental lack of people skills. We’ve all been to one or another doctor who, after materializing God-like and knowing it, proceeded to ask one or two questions, checked his or her watch and instructed which window to pay at, disappearing again before you had a chance to blurt out the thousand or so questions you’d memorized prior to the visit.

In a rite of Worst Fears Realized, greed rears its green Medusa head later on in a discussion of pharmaceutical company payola and its impotent impact in getting Junior back in his school seat.

What’s off-putting about all this is that Groopman’s field of endeavor isn’t psychology (he’s chief of experimental medicine at Beth Israel). This lack of training manifests itself in a paucity of real-world advice (other than trying to relate to your doctor on a professional level) on how actually to get doctors to think in the first place, and fast. As patients, we have enough to do in being sick and figuring out how to pay soul-crushing medical bills. What’s also missing are concrete instructions on getting one’s money back when multiple visits to quacks accomplish nothing, finding competent physicians who possess adequate communication skills, and how to tell when your doctor is utterly lost in the dark and hence posing a real threat to your life.

In the end, the book’s title is only a semi-accurate description of its contents, like medical journalism all too reliant on anecdotal evidence rather than warehouses of data obtained through surveys and such. Footnotes are totally absent. As well, Groopman makes only a minimal effort to debunk the image of doctor as advanced being from heaven, thereby exposing an ignorance of his end users: regular Joes and Flos with aches and pains. C+Eric W. Saeger