Monday, April 02, 2007

How doctors think

A short while ago, while listening to NPR, I heard about this book, written by a doctor who both teaches at Harvard Medical school and writes for the New Yorker. I bought it expecting a grand revelation, because as I understood it, the purpose of the book is not only to explore how physicians think, but to help them overcome the shortcomings of the heuristics used in practice. The perspective I got was that it was targeted at both physicians and patients.

I was a bit disappointed. Perhaps the fact that I am in medical school, in an environment keyed to understanding exactly the concepts laid out here, makes me more informed that the target audience. Certainly, to a layperson, much in this book might be shocking. But to someone behind the scenes, it becomes a set of anecdotes similar to dozens I've heard in the last four years, interspersed with familiar teaching points: maintain an open mind, listen to the patient, consider all the options. The condemnations are familiar as well: insurance under compensates primary care, insurance doesn't cover enough, doctors leap to conclusions. All of which is true, but not new.

In its defense, the book is probably very good for the moderately informed layman, and rereading the laudatory quotes, I see it is not really intended for a physician audience. Certainly, few patients are familiar with a statistic Dr. Groopman cites early in the book, that an experienced physician reaches a diagnosis within 17 seconds of seeing the average patient. Bon mots like that abound for someone who has seen little or been taught little of the workings of a hospital. And the fact that the author is a writer for one of the better-written magazines of our time is evidence of his style and capabilities with language.

Certainly too, the advice he dispenses to patients may be new, and is valuable. Ask good questions, don't be satisfied with cursory explanations, ask what else besides the diagnosis your doctor has settled on could be the problem.

Overall, I enjoyed the book, but my attention was flagging by the final few chapters as it become clear that the exploration of thought was not aimed at a professional audience. The anecdotes serve as warnings and reminders to me, but no more so than any others I've heard. The exhortations to lateral thinking and open-mindedness are no different than that I've heard from my better attendings. And truly, that probably summarizes what this is: an excellent medicine attending writing out his advice to younger physicians in a format a lay audience can understand. Taken for what it is, on that ground, the book is solid and worthwhile. But fellow med students and physicians: don't bother.


Anonymous said...

Sounds like an intersting book. Would it be something to help nurses better understand how Dr.'s think and practice? If so, I am game for reading it. :)

~Anonymous RN

Nathan said...

It might be. Certainly I would agree that the ideas he has about thinking and practicing are very much what is taught in medical schools today.

The Angry Medic said...

"Bon mots like that abound for someone who has seen little or been taught little of the workings of a hospital."

Go ahead, say it, I know it's rolling around there on the back of your tongue - "like the Angry Medic." :)

Actually I've just come over from Ah Yes Med School, where I read the Fake Doctor's last post about passion, as well as your comment. You feel it too? I'm supposed to be working nonstop for my exams now, but somehow I just...can't be arsed. Every med school manual I've ever read (as well as my idol Donald Trump) reminds me that passion is a crucial ingrediant for med school. You mentioned on AYMS that you knew what he meant...are you facing the same problem?

medstudentitis said...

This book is being discussed on the canadian broadcasting corporation (CBC) radio next Saturday on the show great ideas. I'll let you know what they have to say about it.

Nathan said...

Angry medic - yes, I have been facing the same problem. However, this month off to read medical history has been great. Also, I'm posting from the city where I'll be completing my residency, and I just secured a residence for next year, so life is looking up. And if you add in the fact that LOST is on tonight, well, it's just about paradise.

I'll be posting on what I'm reading in medical history once I get back.

medstudentitis - I'd be very curious to hear what they have to say.

Anonymous said...

Hi Jolly,

I am currently reading this book, and while it started out really interesting, it has r e a l l y slowed down for me. I'm not sure why. I am just a lay person who is very interested, nay fascinated by all things medical and I guess I thought it would have more about medicine in it...or something. Oh well, maybe it will pick up, if I give it a chance. I was really looking forward to reading it, as I love books by doctors about their lives...

Thanks for the great blog, tracy in va