Thursday, July 19, 2007

How Doctors Think by Jerome E. Groopman

In How Doctors Think, Jerome E. Groopman is concerned with misdiagnosis of patients' diseases. Early in the text he says that more harm is done through misdiagnosis than through outright mistakes, such as removing the wrong kidney or giving incorrect dosages of drugs. These headline catching mistakes are rare, but treating wrong diseases are not.

Groopman believes the problem stems from physicians not taking time to listen to their patients. He mentions that studies show doctors often interrupt their patients within seconds of the patients starting to explain their condition. The doctors start almost immediately asking narrowing questions. The author says that these physicians have often already started reaching conclusions when they have only slight evidence. Important clues that the patients know are never uncovered by the medical professionals. The book includes many harrowing stories in which patients were treated for the wrong condition because the doctors rushed diagnosis.

Groopman's prescription for doctors is learning to do better interviews, asking open ended-questions and listening. As a reference librarian, I can not help but take notice of this. This is exactly the mandate for the reference interview. First determine what the client really is asking. Let them speak. Time spent at the beginning of the process saves time changing directions later. Perhaps there should be library classes in medical school, and medical students should spend some time at a reference desk.

Groopman's book is already very popular. Every library should have it.

Groopman, Jerome E. How Doctor's Think. Houghton Mifflin, 2007. ISBN 9780618610037

14 comments:

LOVE AND IMMIGRATION CRIER said...

I think Doctors are human same like us all and subject to mistakes which is part of our cultures and traditions otherwise which life becomes incomplete.
Great topic really

Anonymous said...

> How Doctor's Think

Small point, but the title doesn't make any sense. Are you sure it isn't "How Doctors Think"?

Nitpicking stuff aside, I've often felt the same thing about doctors. People need to be given time to build up some confidence and get their thoughts in order. It's a pity that most insurance systems don't reward doctors for time spent with patients, just for treatments prescribed.

A.R. Linder said...

I agree whole heartedly with the comments regarding this book, but I also think that it is one-sided. What about the patient that had the right organ replaced or the person who was correctly diagnosed? Maybe some think that's another book entirely; I think not. Its okay to knock a system, but its also fair to give credit where due. YouthPlay

Tina K said...

In experience of working in a busy OB/GYN practice taught me so much about our health care system. The number one advice I would give is find a nurse practitioner to see for primary care that you are comfortable talking to. They tend to have more time to take with patients. The training and experience they have is doctor-like. In many places, our state for one, NPs are required to work in a practice with a doctor.

This means that your basic needs are attended to by a caring, experienced professional who has time to talk to you (at least by comparison), and your NP has a doctor to consult with when something serious is going on with your health.

House of Brat said...

I remember hearing an interview with the author regarding this book on Fresh Air with Terry Gross.

While doctors are "human", I do think that it has become an expectation by both the patients and the doctors to immediately have an instant solution to every problem regardless of whether one exists or not.

Diar Adhihafsari said...

Hi, Rick (or should I call you Mr. Roche...). I first found your blog address in Blogspot's Blogs of Notes. And I find your blog interesting, really. I haven't had any chance to explore more on your blog, so I wonder whether or not there are any reviews on books on teaching English language. See, I'm teaching English here in a country named Indonesia, and it's sooo hard to find any good references. Well, that's all. Thanks and keep writing the review for us :)

Ruth Anne said...

As a nurse, I believe doctors listen with their brain, and nurses listen with the heart.

(Experiment #6)

Thatsnews said...

I used to have a doctor who would ask you what was wrong with you. I eventually figured out that you were not supposed to say what your thought was wrong. You were supposed to play ignorant, so that HE could tell YOU what was wrong.

Other than that he was a good doctor...

Mary said...

I don't know how it is in the US, but in Australia, (Victoria anyhow)doctors time their patients,zero to fifteen minutes to be charged for one session then a double session once the clock ticks past that fifteen minutes. If you've set yourself up as a business, you haven't got time to listen to your patients.

GSL said...

I tripped over this blog, and in particular this post, by sheer accident, while surfing for ideas on building a blog for my son. This is the book I've been looking for, but forgot the tile of (duhh), following my seeing part of the Groopman's interview with, and appearance on, the Charlie Rose Show, during which he commented on his personal experience with mis diagnosis, and otherwise typical treatment, at the hands of none other than his own colleagues and world class doctors!!!

For "professional patients", it is a confirmation of, sadly, personal experiences. For the average individual, or anyone about to embark on a medically related journey, (at least based on the interview) this is a must read book, so to prepare you for the journey ahead. From an extensive personal experience, all I can advise anyone is to:
* ask any and all question(s) YOU feel that are important;
* get, and keep, copies of ALL of your medical records (labs, images, reports), since you have no idea how important they can be, when you least expect it;
* based on your reading of the labs/reports etc, put the web to use for you. Become an expert in your own disease. www.NIH.gov is a great place to educate yourself, on medical issues.
* get 2, 3, 4 opinions.

One Professor told me that most patients will provide sufficient information for a correct diagnosis, the doctor's job being that of listening for clues!!!

I've dealt with doctors ranging from local quacks, to world renowned professors, researchers and scientists. The best of the lot, welcomed questions, and did not feel in the least insulted, nor intimidated, by being questioned. They treated me not only as a patient, but as one of their students. When all said and done, it is your (or a loved ones) life and welfare. Why would one spend endless hours shopping for a TV/car/whatever, but not for a doctor/remedy?!?

Best of health, and if you can, try getting hold of the interview Groopman had with Charlie Rose on 3/20/07, or at least the transcript - http://www.charlierose.com/guests/jerome-groopman

Anonymous said...

I tripped over this blog, and in particular this post, by sheer accident, while surfing for ideas on building a blog for my son. This is the book I've been looking for, but forgot the tile of (duhh), following my seeing part of the Groopman's interview with, and appearance on, the Charlie Rose Show, during which he commented on his personal experience with mis diagnosis, and otherwise typical treatment, at the hands of none other than his own colleagues and world class doctors!!!

For "professional patients", it is a confirmation of, sadly, personal experiences. For the average individual, or anyone about to embark on a medically related journey, (at least based on the interview) this is a must read book, so to prepare you for the journey ahead. From an extensive personal experience, all I can advise anyone is to:
* ask any and all question(s) YOU feel that are important;
* get, and keep, copies of ALL of your medical records (labs, images, reports), since you have no idea how important they can be, when you least expect it;
* based on your reading of the labs/reports etc, put the web to use for you. Become an expert in your own disease. www.NIH.gov is a great place to educate yourself, on medical issues.
* get 2, 3, 4 opinions.

I've dealt with doctors ranging from local quacks, to world renowned professors, researchers and scientists. The best of the lot, welcomed questions, and did not feel in the least insulted, nor intimidated, by being questioned. They treated me not only as a patient, but as one of their students. When all said and done, it is your (or a loved ones) life and welfare. Why would one spend endless hours shopping for a TV/car/whatever, but not for a doctor/remedy?!?

Best of health, and if you can, try getting hold of the interview Groopman had with Charlie Rose on 3/20/07, or at least the transcript - http://www.charlierose.com/guests/jerome-groopman.
http://www.charlierose.com/search?q=groopman&searchFilter=groopman&searchType=guest&searchTopic=-1&searchFromMonth=MM&searchFromDay=DD&searchFromYear=YY&searchToMonth=MM&searchToDay=DD&searchToYear=YY

Chi girl in Chi town.... said...

I'm an actual RN and 3rd year medical student, and I can honestly say that not listening or asking the right questions can lead to misdiagnosis and/or just wasting of time. Is it the fault of the medical doctor, of course, but I also think that managed care & insurance companies share some of the burden because the time needed for doing a thorough history & physical is usually non-existent. This includes most health care fields, including regular and advanced practice nursing. While not an excuse, it is a major factor as it relates to cause and effect.

I used to dole out great telephone advice based on clinical judgement because I really did spend quality time with my patients. However, the major HMO that I worked for thought I should be able to reduce my time spent talking to patients to 8.5 minutes. Since I found that impossible to do, I thought "screw you" to my employer and just spent as much time as I needed with each patient. It made the job way more enjoyable and also saved mine and the patient's ass in the long run.

Tony Safina said...

First we know that unless we have insurance that covers co-pays we are going to have a hefty medical bill after any serious medical condition, especially one that required surgery. Since we have to pay so much for healthcare we expect our care to be worth it's cost. If it's not worth it's cost we have to pay anyway or suffer bad credit. Doctors need to be able to help a patient or refer them to someone when can render the care they need. When this doesn't happen we feel cheated because bad service shouldn't carry such a high price tag.

Elizabeth said...

I'm a physician who graduated from an osteopathic medical school a few years ago. Most every medical school (both allopathic & osteopathic) teaches classes on interview skills and how to actually listen to what a patient is explaining. However, if you're looking for a physician who is trained to think about the patient in a holistic manner, I highly recommend seeking out an osteopath. One of the fundamental tenets of our education is treating the whole patient - mind, body, and soul. In my many years of education now, I've worked with both M.D.s and D.O.s and can attest to the fact that there is a difference in bedside manner that stems from this basic belief. And really, when it comes down to it, listening is just a part of bedside manner.