Wednesday, November 18, 2009

How Doctors Think, by Jerome Groopman

This was a disappointment: it was painful to read and it lacked useful and well organized information.

Why painful? The author makes his points through anecdotes which are invariably depressing. Attribution error leads to mis-diagnosis: the patient looks a certain way which distracts the physician from even considering other causes then the most obvious. This is similar to the mental prototypes that get in the way of complete diagnoses. Then there's diagnosis momentum, where a choice is made and rationalized even as conflicting data, e.g., test results, appear. People are ignored, erroneously diagnosed, put near death, all due to physician error.

The goal of Groopman's book might have been to help physicians do a better job. Hard to imagine this organization structure would do so; which busy doctor, seeing ever increasing numbers of patients under the scrutiny of insurance payer guidelines, would take the time for this?

The goal might have been to alert patients as to how to minimize if not eliminate such defects in their personal medical care. But there is no clear advice on what information to present, in what fashion, or what specific questions to ask, to reduce the risk of medical failure.

When the author, himself a physician, described years of failure in treating his own medical problem, complete with details of horrible malpractice by three out of four specialists he saw, I just about threw in the towel. My conclusion -- although it is not clear this was Groopman's goal -- is that if you have a medical problem outside the typical 75% of diagnoses, you're screwed. Might as well offer goat's bones to a mushroom scarfing shaman as have optimism in a US teaching hospital or their well-published specialists.

But I told you up front that this was painful to read...