How Doctors Think

How Doctors Think is a 2007 work of nonfiction by Jerome Groopman, chair of medicine at Harvard Medical School and chief of experimental medicine at Beth Israel Deaconess Medical Center in Boston. He is also a writer for The New Yorker magazine. In the introduction to his book, Groopman talks about how there was little research on how doctors think, but he often thought about the topic. He writes that patients can help doctors in finding the answers to their medical problems. He writes: “At the end of this journey through the minds of doctors, we return to language. The epilogue offers words that patients, their families, and their friends can use to help a physician or surgeon think, and thereby better help themselves. Patients and their loved ones can be true partners with physicians when they know how doctors think, and why doctors sometimes fail to think. Using this knowledge, patients can offer a doctor the most vital information about themselves, to help steer him toward the correct diagnosis and offer the therapy they need. Patients and their loved ones can aid even the most seasoned physician avoid errors in thinking. To do so, they need answers to the questions that I asked myself, and for which I had no ready answers.”

Groopman was inspired to write the book after delivering a presentation about compassion and communication. He was asked how patients could determine if a doctor was incompetent, though the doctor might be nonetheless kind. He was reminded of his own work at Massachusetts General Hospita, where he saw patients devoted to their less than stellar doctors. Medical residents were charged with filling in the gaps that the doctors left. Groopman suggests that patients need to be careful of the first impressions they might form of a doctor. Credentials should be as important as personality.

One of the things Groopman explores is heuristic diagnosis. This is when a doctor makes a diagnosis based on similar cases he's seen in his career. This can lead to faulty assumptions and misdiagnosis. He encourages and supports primary care physicians' claims that they are underpaid. He believes this is because in the past, surgeons were the heads of the medical organizations that handled negotiations with insurance companies. There is a misbelief, he says, that primary care is like an entry level position and less sophisticated than other fields of medicine. It is a fallacy that primary care doctors take care of "simple" diseases with specialists taking care of more difficult ones.



Groopman goes on to relate a conversation he had with the chief of cardiology at Boston Children’s Hospital. He asked the doctor, James E. Lock, about mistakes he might have made during his career. Lock said that his errors had similarities. He said that logic, no matter how strong, does not always work. He added that there are times when reasoning from first principles without prior experience did not work because there are variables that need to be considered. Cautiously, he adds that a wrong decisions can lead to the death of a patient.

The book ends with a list of ways patients themselves can help reduce errors. They should think about what else the problem could be beyond the obvious. They must identify symptoms that do not fit and the possibility that they indicate another condition. Open discussion about what a patient is worried about and giving all of the details of the situation from the start are also given as ways to connect with the ways that doctors think.

The New York Times said of How Doctors Think, “This elegant, tough-minded book recounts stories about how doctors and patients interact with one other. In the hands of Jerome Groopman these clinical episodes make absorbing reading and are often deeply affecting. At the same time, the author is commenting on some of the most profound problems facing modern medicine…It is this direct and honest voice that drives the narratives of this remarkable book. Here is Groopman at the peak of his form, as a physician and as a writer. Readers will relish the result.”