Currently reading: Groopman’s How Doctors Think

I just started reading Jerome Groopman’s  How Doctors Think. 1st ed. Houghton Mifflin Company, 2007. . (1st ed. Houghton Mifflin Company, 2007.)     I remember with some fondness “Eyes Wide Open,”  an essay from 2007  in The New Yorker.   I picked this book up in hopes of learning how to better deal with doctors, a skill that would come in useful in both mundane and life and death situations.

From what I’ve gleaned so far, Groopman is focused on the type of misdiagnoses made by doctors, which he writes is dominated by cognitive errors:

In one study of misdiagnoses that caused serious harm to patients, some 80 percent could be accounted for by a cascade of cognitive errors, like the one in Anne Dodge’s case, putting her into a narrow frame and ignoring information that contradicted a fixed notion.  Another study of one hundred incorrect diagnoses found that inadequate medical knowledge was the reason in only four instances.  The doctors didn’t stumble because of their ignorance of clinical facts; rather, they missed diagnoses because they fell into cognitive traps.  Such errors produced a distressingly high rate of misdiagnosis. As many as 15 percent of all diagnoses are inaccurate, according to a 1995 report in which doctors assessed written descriptions of patient’s symptoms and examined actors simulating patients with various diseases.  These findings match  classical research, based on autopsies, which shows that 10 percent to 15 percent of all diagnoses are wrong. (p. 24)

Presumably, I’ll find out from Groopman how I as a patient can help steer my doctors away from cognitive pitfalls that might bring great harm to me and my loved ones.   That’s what I get from:

Different doctors, as we will see in later chapters, achieve competency in remarkably similar ways, despite working in disparate fields.  Primarily, they recognize and remember their mistakes and misjudgments, and incorporate those memories into their thinking. Studies show that expertise is largely acquired not only by sustained practice but by receiving feedback that helps you understand your technical errors and misguided decisions. (p. 21)

Although reviews of this book have been extremely positive overall on, I often turn to critical comments to get a sense of what the book is like. One I found particularly useful is R. Albin’s review of How Doctors Think:

Even more disappointing is Groopman’s attitude towards the most serious effort to rectify this kind of problem, the evidence-based medicine movement. For example, Groopman makes several dismissive remarks about the introduction of Bayesian reasoning in diagnosis and management.

Let’s see how well Groopman does with analyzing the role of evidence-based medicine