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How Doctors Think Paperback – March 12, 2008

4.6 4.6 out of 5 stars 1,280 ratings

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"Must reading for every physician who cares for patients and every patient who wishes to get the best care." —Time magazine

From Dr. Jerome Groopman, Professor of Medicine at Harvard Medical School, Chief of Experimental Medicine at Beth Israel Deaconess Medical Center, and one of the world’s leading researchers in cancer and AIDS, a groundbreaking, profound view of twenty-first-century medical practice, giving doctors and patients the vital information they need to make better judgments together.

On average, a physician will interrupt a patient describing her symptoms within eighteen seconds. In that short time, many doctors decide on the likely diagnosis and best treatment. Often, decisions made this way are correct, but at crucial moments they can also be wrong—with catastrophic consequences. In this revolutionary book, Dr. Jerome Groopman pinpoints the forces and thought processes behind the decisions doctors make, offering direct, intelligent questions patients can ask their doctors to help them get back on track. Drawing on extensive interviews with some of the country’s best doctors and Groopman's own experiences as a doctor and as a patient, How Doctors Think reveals an important approach to twenty-first-century medical practice, giving doctors and patients a way to make better judgments together.

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Editorial Reviews

Review

"Must reading for every physician who cares for patients and every patient who wishes to get the best care." — Time

"Every reflective doctor will learn from this book. . . every prospective patient will find thoughtful advice for communicating successfully." — Publishers Weekly (starred review)

"[Groopman's] most essential book yet." — Boston Phoenix

“Groopman has written a unique, important and wonderful book…You’ll never look at your own doctor in the same way again.”  — Steven D. Levitt and Stephen J. Dubner, bestselling authors of Freakonomics

“Splendid and courageous. . . Groopman lifts the veil on the most taboo topic. . . the pervasive nature of misdiagnosis.”  — Ron Chernow, New York Times bestselling author

"A sage, humane prescription for medical practitioners and the people who depend of them." — O, the Oprah Magazine

"A cogent analysis of all the wrong ways his fellow practitioners are trained to approach the patients they treat." — Elle

"A book to restore faith in an often-resented profession." — Booklist

About the Author

Jerome Groopman, M.D. is the Dina and Raphael Recanati Professor of Medicine at Harvard Medical School, Chief of Experimental Medicine at Beth Israel Deaconess Medical Center, and one of the world’s leading researchers in cancer and AIDS. He is a staff writer for The New Yorker and has written for The New York TimesThe Wall Street Journal,The Washington Post and The New Republic. He is author of The Measure of Our Days (1997), Second Opinions (2000), Anatomy of Hope (2004), How Doctors Think (2007), and the recently released, Your Medical Mind.

Product details

  • ASIN ‏ : ‎ 0547053649
  • Publisher ‏ : ‎ Mariner Books; Reprint edition (March 12, 2008)
  • Language ‏ : ‎ English
  • Paperback ‏ : ‎ 319 pages
  • ISBN-10 ‏ : ‎ 9780547053646
  • ISBN-13 ‏ : ‎ 978-0547053646
  • Item Weight ‏ : ‎ 2.31 pounds
  • Dimensions ‏ : ‎ 5.5 x 0.75 x 8.25 inches
  • Customer Reviews:
    4.6 4.6 out of 5 stars 1,280 ratings

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Jerome E. Groopman
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Jerome Groopman, M.D., holds the Dina and Raphael Recanati Chair of Medicine at Harvard Medical School and is chief of experimental medicine at Beth Israel Deaconess Medical Center in Boston. He has published more than 150 scientific articles. He is also a staff writer at The New Yorker and has written editorials on policy issues for the New Republic, the Washington Post, and the New York Times. His previous books include the New York Times bestseller The Anatomy of Hope, Second Opinions, and The Measure of Our Days. Groopman lives in Brookline, Massachusetts.

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4.6 out of 5 stars
1,280 global ratings

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Customers say

Customers find the book enjoyable and helpful for patients. It provides concrete ideas and advice for responding to challenges. Readers describe it as insightful, well-written, and easy to understand. The book is praised for its clear presentation of medical challenges from an insider's perspective.

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152 customers mention "Readability"152 positive0 negative

Customers find the book easy to read and helpful for patients. They say it's enjoyable in parts and explains how doctors think. Some readers consider it one of the author's best books.

"...This is one of the best books that he has written, about one of the issues that may lead to medical errors: simply not thinking well...." Read more

"...This book was worth reading!..." Read more

"...Dr. Groopman is an excellent writer, so the book is easy and enjoyable to read, and never gave me that feeling of "just wanting to get it over with...." Read more

"...Overall, I loved this book...." Read more

148 customers mention "Insight"144 positive4 negative

Customers find the book insightful and helpful for patients. They appreciate the detailed analysis of doctor thinking that helps improve their thinking. The book provides an engaging way to learn about thinking errors and how physicians are trained.

"...Groopman does a compelling job throughout the book in making sure he relates the plights plaguing medicine from both sides of the coin, from the..." Read more

"...This book a look at how physicians are trained, and how their training as well as their experience impacts the way physicians think, and diagnose..." Read more

"Dr. Groopman is an eminent and wise physician who has written this honest and incisive book on "how doctors think."..." Read more

"...to be familiar to most physicians, it will make you think critically about your practice behaviors and how to improve upon them, as well as the..." Read more

45 customers mention "Readable"45 positive0 negative

Customers find the book easy to read and well-written. They appreciate the author's humility, humor, and empathy. The ideas are presented in a clear and concise way. Readers find the book informative and worth reading.

"...Dr. Groopman is an excellent writer, so the book is easy and enjoyable to read, and never gave me that feeling of "just wanting to get it over with...." Read more

"I am sure that Dr. Groopman is a nice man and the book was easy and informative...." Read more

"...Dr. Groopman writes an excellent, insightful and readable text on how we make and sometimes mistake clinical decisions...." Read more

"...Dr Groopman presents his ideas in a very clear and concise way...." Read more

8 customers mention "Look"8 positive0 negative

Customers like the book's appearance. They say it provides a deep look from an insider and is erudite but not dry. The presentation of some of the challenges of practicing medicine is excellent, and it was recommended by a senior doctor.

"A fascinating look into the minds of good and bad doctors. Once in the emergenicy room I met a good doctors but ......" Read more

"...It not only looks analytically at medical pattern of thinking but also points its many strengths and weaknesses...." Read more

"...This book provides a deep look from an insider. It's erudite but not dry...." Read more

"An excellent presentation of some of the challenges of practicing medicine and the expectation of being infallible to which none of us can live up...." Read more

Top reviews from the United States

  • Reviewed in the United States on May 28, 2007
    Most doctors are highly educated, hard working people. They may sometimes get a bit tetchy because they overwhelmed by the demands made on them, but most of the time they do their best. Yet in our blame culture there are places in America where you can't get a specialist to treat you: they have all been driven out of business by lawyers representing unhappy clients. The question of why this has come to pass has occupied the minds of the American medical profession for three decades.

    For more than a decade, Groopman's trenchant analyses have always been illuminating, and he has a rare gift for communicating them.

    This is one of the best books that he has written, about one of the issues that may lead to medical errors: simply not thinking well. It is a very real factor. We all - and not just doctors - jump to conclusions; believe what others tell us and trust the authority of "experts." Clinicians bring a bundle of pre-conceived ideas to the table every time that they see a patient. If that have just seen someone with gastric reflux, they are more likely to think that the next patient with similar symptoms has the same thing, and miss his heart disease. And woe betides the person who has become the "authority" on a particular illness: everyone coming through his or her door will have some weird variant of the disease. As Abraham Maslow once said, "If the only tool you have is a hammer, you tend to see every problem as a nail." To that we have to add that not all sets of symptoms fall neatly into a diagnostic box. That uncertainty can cause doctors and their patients to come unglued. Sometimes when doctors disagree it is based not on facts, but on different interpretations of this uncertainty.

    On this one topic the book is very good as far as it goes, thought I do think that the analysis is incomplete.

    I have taught medical students and doctors on five continents, and this book does not address some of the very marked geographic differences in medical practice. While I think that the book is terrific, let me point out some of the ways in which it is "Americano-centric."

    The first point is that the evidence base in medicine is like an inverted pyramid: a huge amount of practice is still based on a fairly small amount of empirical data. As a result doctors often do not know want they do not know. They may have been shown how to do a procedure without being told that there is no evidence that it works. As an example, few surgical procedures have ever been subjected to a formal clinical trial. Although medical schools are trying to turn out medical scientists, many do not have the time or the inclination to be scientific in their offices. In day-to-day practice doctors often use fairly basic and sometimes flawed reasoning. A good example would be hormone replacement therapy. It seemed a thoroughly good idea. What could be better than re-establishing hormonal balance? In practice it may have caused a great many problems. Medicine is littered with examples of things that seemed like a good idea but were not. Therapeutic blood letting contributed to the death of George Washington, and the only psychiatrist ever to win a Nobel Prize in Medicine got his award for taking people with cerebral syphilis and infecting them with malaria. The structure of American medicine does not support the person who questions: consensus guidelines and "standards of care" make questioning, innovation and freedom very difficult. A strange irony in a country founded on all three.

    The second major factor in the United States - far more than the rest of the world - is the practice of defensive medicine: doctors have to do a great many procedures to try and protect themselves against litigation. This is having a grievous effect not only on costs, but also on the ways in which doctors and patients can interact.

    Third is the problem of demand for and entitlement to healthcare. We do not have enough money for anything: but what is enough if the demand for healthcare continues to grow as we expect? And if people are being told that it is their right to live to be a hundred in the body of a twenty year-old? Much of the money is directed in questionable directions. There are some quite well known statistics: twelve billion dollars a year spent on cosmetic surgery, at a time when almost 40 million people have no health insurance. There are some horrendous problems with socialized medicine, but most European countries have at least started the debate about what can be offered. Should someone aged 100 have a heart transplant? Everyone has his or her own view about that one, but it is a debate that we need to have in the United States.

    Fourth is the impact of money on the directions chosen by medical students and doctors starting their careers. Most freshly minted doctors in the United States have spent a fortune on their education, so they are drawn to specialties in which they can make the most money to pay back their loans. In family medicine and psychiatry, even the best programs are having trouble filling their residency training programs. Many young doctors are interested in these fields, but they could die of old age before they pay off their loans.

    Fifth is the problem of information. It is hard for most busy doctors in the United States to keep up to date on the latest research, and many are rusty on the mechanics of how to interpret data. So much of their information comes from pharmaceutical companies. Many of the most influential studies have been conducted by pharmaceutical companies, simply because they have the resources. But there have been times when data has therefore appeared suspect. Industry is not evil, but companies certainly hope that their studies will turn out a certain way, and the outcome of any study depends on the questions asked and the way in which the data is analyzed. And like any collection of people, it is easy to fall into a kind of groupthink. There are countless examples of highly intelligent individuals who all missed the wood for the leaves. "Our product is the best there's ever been, and we are all quite sure that the stories about side effects are just a bit of "noise" created by our competitors." That topic alone could provide much grist for Dr. Groopman's mill.

    Another related problem is that many scientists are now also setting up companies to try and profit from the discoveries that they have made in academia. Most are working from the highest motives, but sometimes there are worries about impartiality. So once again, the unsuspecting physician may add data to the diagnostic mix without knowing its provenance. There have recently been a number of high profile examples of that.

    It could well be that Groopman will cover all of these points and more in his next book, and I can, of course, be accused of criticizing him for not writing the book that "I" wanted!

    This is a book that should be read by every doctor and patient in America.

    It is also good to know that there are other ways of thinking about some of the problems before us.

    Very highly recommended.
    93 people found this helpful
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  • Reviewed in the United States on July 20, 2016
    There are doctors that follow the tune that the Medical Industrial Complex plays, and there are ones who buck the trend. Dr. Groopman is one of the latter, thankfully.

    In How Doctors Think, The New Yorker staff writer and Harvard professor of medicine & researcher Dr. Groopman offers a distinctive look into the structure of Big Medica in search for what exactly is the type of mindset Doctors employ when practicing their jobs.

    Groopman does a compelling job throughout the book in making sure he relates the plights plaguing medicine from both sides of the coin, from the patients perspective, as well as from the perspective of a physician. This aids in the book not being one sided. It helps greatly that he’s also a Doctor with experience in this very field.

    From medical, money, marketing, uncertainty, dogma, to various other components of medicine, Groopman attempts to turn over as many stones as possible in his search for what issues are the ones plaguing Doctors the most.

    A notable point in the book that hit close to home, which many people will relate to is the emotional tension that can arise at times between patients and their doctors. Essentially, whether patients and doctors like each other. Groopman relates what Social Psychologist, Judy Hall discovered regarding emotional tension:

    “..that those feelings are hardly secret on either side of the table. In studies of primary care physicians and surgeons, patients knew remarkably accurately how the doctor actually felt about them. Much of this, of course, comes from nonverbal behavior: the physician’s facial expressions, how he is seated, whether his gestures are warm and welcoming or formal and remote. “The doctor is supposed to be emotionally neutral and evenhanded with everybody,” Hall said, “and we know that’s not true.”[1]

    What’s worse, is that Hall’s research indicated:

    “…that the sickest patients are the least liked by doctors, and that very sick people sense this disaffection. Overall, doctors tend to like healthier people more.”[2] So much for quality health care.

    Along with the above example, the author additionally notes many other examples of issues that arise due to a crisis in communication which can arrive in myriad ways.

    In fact, one of these issues that Groopman relates is that:

    “…on average, physicians interrupt patients within eighteen seconds of when they begin telling their story.”[3]

    Another salient aspect of Big Medica that the author sunk his teeth into was the psychological aspect of medicine. Predictably, far too often doctors/western medicine view the patients psychological components as being apart from the body, rather than taking a much-needed holistic approach.

    Additionally, the institutional dogma that reigns down from the top is also touched upon in a few instances by the author. Open-mindedness is scoffed at, while conformity was expected.

    Recounting an example of choosing between the availability of multiple medical options regarding a particular treatment, Groopman relates something noted by physician Jay Katz, who taught at Yale Law school at the time:

    “In both [treatments]…we were educated for dogmatic certainty, for adopting one school of thought or the other, and for playing the game according to the venerable, but contradictory, rules that each institution sought to impose on staff, students and patients.”[4]

    Another disturbing component that doctors acquiesce to that is covered by Groopman is how doctors far too often give into to corporate interests. This very issue has covered by other doctors such as Dr. Brogan, Dr. Breggin, Dr. Mercola and many others.

    This book sheds much needed light into the inner workings of how doctors operate – how they think. While the author notes that a sizeable amount of the issues have a variety of roots at the outset, such as communication, what he conveys still leads to much concern within the Medical Industrial Complex.

    In the end, individuals will need to become much more proactive/responsible in their health if they plan to breakaway from the conventional medical system that puts profits over people.

    ____________________________________________________________________________________

    Sources & References:

    [1] Dr. Jerome Groopman, M.D., How Doctors Think, pg. 19.
    [2] Ibid., pg. 19
    [3] Ibid., pg. 17
    [4] Ibid., pg. 153

    Kindest Regards,
    Zy Marquiez
    TheBreakAway.wordpress.com
    34 people found this helpful
    Report

Top reviews from other countries

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  • Dawn
    5.0 out of 5 stars Excellent information Very revealing
    Reviewed in Canada on January 20, 2024
    Excellent book. Full of info that is useful. Love the book. Definitely worth reading. I even loaned my copy to a friend. The story in first chapter of how this female patient is misdiagnosed, not believed and given the run around until she sees the doctor who wrote this book. He actually listens to the patient tell her story and as a result correctly diagnosis her. Powerful book!
  • Dr BMS
    5.0 out of 5 stars One of the best books I have ever read.
    Reviewed in India on December 9, 2023
    This seems to be a classic master piece write-up. It is a MUST reference for both patient and doctor. Very useful for business professionals too.
  • Rui Carvalho
    4.0 out of 5 stars Boa aquisição
    Reviewed in Spain on May 10, 2024
    Dentro do esperado.
  • vitoria caliari
    5.0 out of 5 stars Recomendo
    Reviewed in Brazil on April 3, 2021
    Muito bom
  • Client d'Amazon
    5.0 out of 5 stars Amazing insights !
    Reviewed in the United Arab Emirates on May 8, 2023
    I have enjoyed this book very much and recommend it to every health practitioner!