How Doctors Think: A Book for Patients & Families

Published by Beth Campbell Duke on

How Doctors Think (Jerome Groopman) - book review

An Introduction to ‘How Doctors Think’

I first saw Dr. Jerome Groopman’s book, ‘How Doctors Think’ on a shelf in the office of a pain clinic nurse when Tony was in for an assessment.

I am so glad I asked to borrow and read it!

Jerome Groopman, M.D. explains how doctors are trained to think and diagnose. Like any system, diagnosis is subject to limitations and sometimes outright failure. In healthcare, this means that people are misdiagnosed and can be inappropriately treated. Misdiagnosis can be life-altering or fatal.

Dr. Groopman doesn’t leave us there. He does outline some things we can do to help our healthcare professionals avoid the pitfalls of the process. I’ve incorporated them into our own note-taking practice (you can get access to that info below).

If you’re frequently involved with the medical system due to a chronic illness or one that seems to defy treatment (potentially due to misdiagnosis), then understanding ‘How Doctors Think’ is critical in helping you more effectively interact with the healthcare professionals you visit.

  • Our society’s medical knowledge has grown so exponentially that it’s critical patients and families take on more responsibility for our own medical care.
  • We can’t expect every doctor to understand every aspect of health care – and our journeys are all different. This means understanding ‘How Doctors Think’ and learning what questions to ask to help avoid diagnostic and treatment errors.

The Main Issues

Groopman outlines 4 main problem-solving issues that can trip up not just doctors, but any of us and then leaves us with 5 questions to ask when you’re working with your doctor towards a diagnosis.

Here are the issues:

  • The ‘Availability Heuristic’ is the fancy way of saying that we are prone to choosing the explanation we’re most familiar with at the expense of thinking about alternatives. This happens in a medical context because the same symptoms can be seen in a number of ailments – some much more common than others.
  • Lack of recognition for primary care physicians… and an over-recognition of specialists. We tend to think about GPs as ‘entry level’ medicine and that specialists have this ‘entry-level’ knowledge plus knowledge about their specialty. This isn’t always the case. Specialists tend to focus on solutions that fit their specialty. My mother once had a thyroid issue that her GP wanted to explore a bit further before sending her to a surgeon – because as he said, ‘a surgeon will do surgery.’ Surgery isn’t necessarily the wrong course of action, but it isn’t always the only one.
  • The ‘Logic Fallacy’ happens when logic is the sole thought process used when making a diagnosis and treatment plan. There are multiple variables when dealing with biological systems and human physiology – and psychology. Logic on its own doesn’t work in every case. Doctors who have more experience in a given area will have seen a variety of outcomes.
  • Discomfort with uncertainty. Doctors are in a profession that carries an expectation of success. People put their faith in doctors to figure out what’s going on, to take action and to actively fix things, so both doctors and patients can have an expectation that there is ‘an answer’ and ‘a solution’. In difficult or complex cases there can be significant uncertainty, and we need to understand that uncertainty doesn’t equate with incompetence.

Being a patient or caregiver to a patient with a chronic and/or complex health issue is tough. Learning to interact in a healthcare setting is one aspect of the ‘new work’ we pick up as patients and families managing critical and/or chronic illness.

We found the information in Dr. Groopman’s book very helpful!

Communicating with your healthcare team members can take some effort. Dr. @Groopman's book 'How Doctors Think' gives us some key information on how to communicate more effectively. Click To Tweet

What Patients and Families Can Do

These are the questions to ask for both the physician and patient:

  • What else could it be? This is a better question than ‘Is there anything else it could be’ because ‘What else…’ is an open-ended question. Avoid asking ‘yes’ or ‘no’ questions – or you’ll just get a ‘yes’ or ‘no’.
  • What doesn’t fit? It’s too easy for any of us to discount the bits that don’t fit. When we specifically ask which parts don’t fit, it can help broaden our thinking.
  • Is it possible I have more than one problem? We often look for the ‘one right answer’. Sometimes there are multiple ‘right’ answers.
  • Tell what you are most worried about. By communicating what you’re most worried about, the doctor can reassure you and/or can get some valuable information for further analysis. What if this had happened to your Aunt Mary – and that family link hadn’t been disclosed before? (For example 😉 )
  • Retell the story from the beginning. Sometimes we miss out on pertinent details when we’re first telling the story. Sometime new details emerge that can be helpful. Retelling the story is helpful when there seems to be a block getting to a helpful diagnosis.

This book had such an impact on us that we include Groopman’s questions on our ‘Clinic Notes Sheet’.

You can get a copy of this helpful sheet in the ‘3 Things Patients & Families Need to Know About Our Healthcare System’ download that you get when you sign up for our mailing list.

Beth Campbell Duke

Beth is a science educator and family caregiver for her husband, Tony, and her parents. She's busy developing programs and materials to help other patients and family caregivers navigate the healthcare system and tell their stories. Beth's biggest wish is to see the healthcare system incorporate 'trauma-informed care' into its workplaces to address the growing number of healthcare providers, patients and family caregivers experiencing primary and secondary trauma.