How Doctors Think

Verna Noel Jones, Special to the Rocky

Friday, April 13, 2007

• Nonfiction. By Jerome Groopman. Houghton Mifflin, $25. Grade: A

Book in a nutshell: Even brilliant doctors make misdiagnoses or choose the wrong therapy for a patient, says Groopman, chief of experimental medicine at Beth Israel Deaconess Medical Center, Boston, whose previous books include Second Opinions and The Anatomy of Hope. The problems arise in errors in thinking, often through snap judgments or ineffective communication. Yet Groopman believes there is much a patient can do to help prevent mistakes.

This book examines when and why doctors' thinking goes right and wrong, making its case through interviews with numerous top physicians and patients. In one example, an endocrinologist recalls seeing an unshaven, uncooperative young man in the emergency room and making a snap decision that he's simply a homeless hippie. In fact, with the help of an observant ER nurse, the doctor soon realizes that the patient is not a vagrant but a very sick student on the brink of a diabetic coma.

Insurance companies also can sway doctors toward doing more costly and sometimes unnecessary surgeries for financial gain. A spinal fusion operation, for instance, may bring a surgeon a $20,000 reimbursement versus $5,000 when he performs a simple discectomy. Yet the latter may be the better choice for the patient. Groopman shares not only the errors of others but his own incorrect diagnoses and what he has learned.

Best tidbit: The author laments the concerted effort by drug companies to create clinical disorders by "medicalizing" normal life changes. For example, men's waning sex drive as they age now is considered a disorder that needs a "cure." Groopman favors ethical marketing of medications so they aren't prescribed unnecessarily.

Pros: The book forces you to rethink your blind trust in even the most highly respected doctors, or radiologists, who misread X-rays up to 27 percent of the time, studies show.

Cons: None.

Final word: Through riveting personal stories, Groopman offers a clear message: Don't be shy when it comes to your own health - it could make a difference between life and death.