Nursing Book Club

How Doctors Think

A good diagnostician solves the puzzle of patient symptoms.

By Jerome Groopman, M.D.; Houghton Mifflin, 2007
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Reviewed By Christine Contillo, RN, BSN

How Doctors Think, by Jerome Groopman, M.D., is the key to understanding how a good diagnostician solves the puzzle of patient symptoms. Nurses everywhere may find themselves less frustrated in their daily work after reading it. After all, we’ve all watched a doctor take a history and zero in with questions on a seemingly insignificant fact. While pursuing something that seems pointless to us, he’ll have an “a-ha!” moment and arrive at a diagnosis. And who hasn’t spent time trying to guess which battery of tests the doctor will order to fit this particular syndrome?

How Doctors ThinkDr. Groopman begins by introducing us to Anna Dodge, a woman who may have seen close to 30 physicians in her search for the root of her gastro-intestinal problems. He explains why her doctors had missed the important clues. (I guessed the disease correctly by page 15, but that could be because I know someone with the same illness, or maybe it’s because nurses in general pay close attention and trust their intuition.)

The author explains why some doctors are better than others at getting to the bottom of unusual diseases, how doctors are trained to think, and why algorithms make their life easier. He gives some very good advice along the way, giving the reader some simple rules on how to be a “better patient" — don’t interrupt when the doctor is questioning because, just like anyone else, he may become distracted. Don’t offer your own internet-search diagnosis because he may be just complacent enough to let you do all the work and run with the answer you found instead of digging deeper.

Dr. Groopman bemoans the insurance rules that limit the time a physician spends with a patient, and worries that too many doctors don’t see beyond the person sitting right in front of them. A non-complaint patient may in fact be simply unable to read the written instructions handed to him, or unable to understand medical lingo. He concedes that medicine is truly an art, explains that many answers are still unknown, and that logic can’t solve every medical mystery. Some doctors, despite equal training and time spent in practice, really are better than others. Thus the smartest guy isn’t always the one to whom you’d trust surgery on your child.

How Doctors Think is valuable on many levels, including affirming a few things we already know — that these pesky drug companies and their marketing techniques DO make a difference in what prescriptions are ordered, and that the continuing education meetings doctors attend are much more fun than ours, even if the same amount of learning takes place.

In his explanation of How Doctors Think, Dr. Groopman seems to be pointing a finger at many of the systems that fail to help. When you’ve finished this book you’ll be better equipped to understand how your physician arrived at his diagnosis, but you may still not be able to read his handwriting.

Purchase How Doctors Think from Amazon

Written By Christine Contillo, RN, BSN, has worked as a nurse since 1979, and has written extensively for various nursing publications as well as The New York Times.

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