How Doctors Think by Jerome Groopman ISBN: 9780618610037
A "New Yorker" staff writer, bestselling author, and professor at Harvard Medical School unravels the mystery of how doctors figure out the best treatments--or fail to do so. This book describes the warning signs of flawed medical thinking and offers intelligent questions patients can ask.
This message has been edited by chapteraday on Jul 1, 2008 2:29 PM This message has been edited by chapteraday on Jul 1, 2008 11:33 AM
Does it exist? Yes,just as economic, evolutionary,or ecological philosophy
exist. The question is where do I read about the subject of medical
philosophy?
According to major critics among readers of Groopman's book on Amazon, the
doctor is somewhat "gone fishing". He seems both too "intuitive"[a
non-verbal,vague,even dismissive approach],and unsupportive of analysis.
This could be good, but there is little substance in this particular
balancing act.
I will be trying to get some perpective on my question: I'm guessing
already that an approach through evolutionary-ecological philosophy is our
best approach. Such a mine field though! All kinds of mines, and minds.
The basic nature of nature/universe, including humans, is where it's at,
and where we want to be. We start with faith in evecology as love, or why
bother if the universe[and humans] is junk/"out to lunch"?The mote in the
eye of the beholder[ i.e. humans] is the problem. Humans are always the
problem. Or "snamuh", humans "spelled" backwards, to be more specific and
accurate.
Have just finished reading the quite long introduction to this book - it is both hopefully informative and enormously scary - tho' the misdiagnoses say 15% - that IS 15% - I agree that a patient should be a partner with the doctor, but not all patients are that unintimidated and not all doctors are that openminded and willing to answer questions by the patient -
If nothing else, this book should make us all think and be willing to ask questions of our doctors and if are not satisfied with ongoing problems have the courage to not be intimidated by the "white coat thinking" of the past and change doctors and/or go to a specialist without waiting for our family doctor to decide when to refer us -
As a retired nurse and sometime patient, as well as someone who really enjoys a good mystery, the opening of this book has drawn me right in, and I will read the rest of it. I am happy to report that some of the newer/ younger doctors have not acquired the "God complex" and do respect the nurses opinions and even seek them out.
Time! I wish all MDs and nurses had more time to listen to patients.In our rush rush hurry up society it seems more like a race. As an RN x 29 + yrs (and a surgical patient once which was enough) I am enjoying this book.Once a patient is hospitalized, nurses have the benefit of actually being with the patient for hours and hours, days, etc.(Well, at least in the old days we did, actually working for long stretches at the bedside!)The doctors have...minutes? Many, many times my nurse friends and I have felt intuitively what might be going on (or not) with a patient. We assemble the various numbers, facts and observations and use these to communicate to the rest of the health care team to assist in care of the patient. Interestingly, this possibly leads us as nurses in what/how we report to the doctors who make the final diagnosis and prescribe treatment.Nurses do not legally "diagnose" but yet we may influence how a doctor comes to his/her diagnosis. This could be good or bad! Sometimes the "numbers" just don't make sense or may look perfectly fine but intuitively, we sense something is in indeed wrong. I have called docs over the yrs and told them "he/she is stable etc but something here is not right". I've also seen patients with "bad numbers" whose bodies have been compensating for so many years that they are not critical for that particular patient! There is definitely an ART to healthcare as well as science. I had a head nurse ions ago who could walk into our post anesthesia unit and know almost instantly which patient(s) were not doing well. And she was right every time. The best advice someone gave me decades ago was "Look at/treat the *patient*, not the monitors!!"
Todays' entry was gave me insight into the thinking of my present, 30 something GP. My long-time GP was more instinctive pulling on years of practice and observation. My current GP basically uses the algorithim method. Now I understand the path of her questioning.
I am not sure I would buy this book however, I will look for it in the library.
As a nurse and patient, I have seen algorithm doctors, [and nurses], and intuitive ones. When anyone regardless of career or specialty think only of what the norm is or what the textbook says, or what your algorithm comes up with there will be mistakes. People are individuals. Every part of our bodies interact with each other. Our minds, spirit, and body interact. That makes us individuals. Individuals don't fit in a box. Just because a drug is effective for most people doesn't necessarily make it effective for me, or the side effects may affect me differently. Everybody, not just doctors can make the mistake of pigeonholed assumptions.
This book is quite interesting and i wanted to share something i thought interesting also, when my daughter was sick and in the hospital after she was released i went to fill her prescription she had been given. The pharmacist told me my insurance (one of the big company's) would not pay for it, they wanted her to try taking something else first for five days and it wasn't just a generic of the script. I was so upset i just paid for what the hospital doctor prescribed. Last nite i took my elderly aunt to her doctor that she has had for years and he told us he was retiring because he was so stressed about having to give less medical care than he wanted to his patients because the insurance company's would tell him that tests, and medicine he would request for his patients were often denied by his patients insurance(most older patients, medicad, etc) and he would end up spending so much time arguing why he needed those things to be done. He said he went to medical school 40 yrs. ago and practicing medicine with his patients best interest is just a thing of the past with the powerful insurance companies acting like they are the physician and he was getting so upset he just felt it was time for him for his health to retire. So we all pay astronomical prices for our health insurance and our doctors who know because they were trained in the medical field now have to answer to the insurance companies first before treating their patients, how can this be?
Donna, I too was told by my pharmacist that they would not fill a prescription because the insurance company requested a cheaper medication. Of course the cheaper medication didn't work that's why I needed the other one. Yes, this is bad medicine.
The opening of this book sounds familiar. I was the caregiver for my mother in her last years and I don't remember a time in my life when my Mom wasn't searching to find out what was making her sick. Doctors put her on countless diets, forced her to seek mental health treatments when all else failed, and never pinpointed a specific problem. She passed away at age 50 and I am still rather traumatized by my experiences as a young daughter (I was 25) trying to naviagate the health care system and take care of my mother while doctors ignored me, dismissed me, or rushed me away.
This book is a great idea and I am enjoying it. I only wish the author hadn't chosen to only refer to doctors exclusively with the male pronoun, 'His' diagnosis, etc..." I can't help but wonder if doctors' thinking is slightly different in female doctors...maybe he will go into that, as well.
Speaking of diets, has anyone NOT heard "low fat, low sodium, high fiber"? I am not willing to pay a dietitian or MD large fees to be told the same thing every health article in every magazine and online states. I expect more from them.
Excuse my difficulties in previous post: Now in decent prose, rather than stupid poetry---
Does it[medical philosophy]exist? Yes, just as legal, economic, evolutionary, or ecological philosophy exist. Our question is: Where do we read about the subject of medical philosophy?
According to a few readers of Groopman's book,as reported in Amazon's book reviews, Dr. Groopman is somewhat "gone fishing": He seems both too "intuitive"[non-verbal, vague, even dismissive] and unsupportive of analysis,in the showdown. This could be good, but there may be little substance in Groopman's particular balancing act.
I hope to be gaining some perspective on my philosophical question. I'm guessing already that a strenuous approach through evolutionary-ecological philosophy, evecosophy if you will, is our most basic way to the true-love of medicine[or anything, for that matter]. Such a mine/mind field though!
The basic nature of nature/universe, including--of course--humans, is where it's at. And where we want to be. We start with faith in evecology as love, or why bother if the universe[and humans] is junk/"out to lunch"?
The mote in the eye of the beholder[i.e.humans] is the problem. Humans are always the problem on Earth. The universe, and planet,are, when not ill-treated, absolutely healthy; ipso facto humans too.
Is there a medical philosophy--give a reference book--that is holistic,or thoughtful,not merely analytical or non-verbally intuitive? The answer, I believe,is beyond medicine, in general philosophy, or better still, in soPhilogic, the logic of love[re: Jesus, Buddha, Zoroaster, Zhuangzi, and even in Darwin's Theory of Divergence].
After finishing this week's readings, I am impressed by the book. How do I as a nurse ask about pain, with closed ended questions or open. I'll try to be more open, but sometimes the question has to be narrowed when you get a blank stare or "I don't know" for an answer. I am ordering this book.
