Dr. Jerome Groopman Theorizes Middle-Aged Women Often Misdiagnosed Due to Doctor Preconceptions
I have long been a fan of Dr. Jerome Groopman, a world famous oncologist and Harvard Medical School professor, who writes for the New Yorker. He has a new book out called How Doctors Think (Houghton Mifflin Company). I haven't read the entire book yet but have reviewed several excerpts that ran in the New Yorker. The other night I caught Groopman on the Stephen Colbert show, where he articulated some of the book's main ideas.
Dr. Jerome Groopman appeared on Comedy Central's Colbert Report on 3/19/07.
Groopman's thesis is that doctors make mistakes diagnosing patients, usually because they are making snap assumptions from their guts about what's wrong with their patients, and not using their brains enough. You have to like a doctor who admits that he and his colleagues make mistakes. A fellow New Yorker regular and Harvard Medical School faculty member, Atul Gawande, covered similar terrain in his debut book, Complications: A Surgeon's Notes on an Imperfect Science, published in 2002.
Groopman's New Yorker pieces are written beautifully, and his compassion shines through. He is on the side of the patient, which I have not always found to be the case in real life, where doctors' egos and arrogance can get in the way.
How Doctors Think aims to help patients get better care from their imperfect doctors by asking them better questions. For example:
- What else could it be?
- Is there anything that doesn't fit?
- Is it possible I have more than one problem?
Many medical errors, Groopman says, are based on flaws in doctor thinking, and then, the inability to consider that they might have gone down the wrong path and to reconsider. To me, it's not how many errors doctors make that is important. It is the possibility of serious consequences for the patient of a misdiagnosis--pain, suffering and even death.
Groopman gave an example on the Colbert Report that really hit home to me: Middle-aged women are the most likely to be misdiagnosed because doctors often assume their problems are due to menopause or stress and not an underlying illness.
Groopman gives several examples of errors he had made and how that led to bad outcomes for his patients. Sometimes, liking a patient too much can be as harmful as not liking them. For example, he was trying to spare a cancer patient with a fever some discomfort on hospital rounds, and he didn't do a thorough physical examination. Thus, he missed an abscess on the patient's buttocks, which caused the man to become dangerously ill, until other doctors discovered it. In that case, Groopman's sympathy for the patient actually caused harm.
On The Charlie Rose show another night (I was asleep but my husband reported it to me), Groopman also made a point that I have long believed: If you don't like the doctor, or the doctor doesn't like you, you are not going to get the best care. These negative vibes definitely get in the way of the diagnosis.
In my experience, this cuts both ways. The respect and trust I have in my oncologist, who had treated me for blood disorders during my pregnancies, several years before my breast cancer, allows us to have an ongoing dialogue about my continuing treatment. He has always welcomed my journalistic approach of asking a lot of questions about research I have read, or new drugs or treatments.
His openness to my questions is a sign that he is secure--and it is a standard I use with my other doctors, who don't always welcome my questions, or, I should admit, my propensity to self-diagnosis, without the benefit of any medical training. Even if I sometimes take it to extremes, as Groopman says, working with your doctors is part of your job as a medical consumer. And follow your instincts. If you have a doctor who you don't like, get out of there.
For more on Dr. Atul Gawande, please visit our special section:
Published On: March 22, 2007