Heroes Not Zombies

“How Doctors Think” by Jerome Groopman (ISBN 978-0-618-61003-7) should be on the recommended reading list of every medical student and doctor. Dr Groopman is a physician who specialises in Haematology. This book is the best presentation on the cognitive processes involved in medical decision making I’ve ever read. Actually it’s main focus is on how doctors make a diagnosis and on their cognitive errors which result in them missing or mistaking the correct diagnosis. It’s clear and it’s comprehensive. It’s the kind of book that stimulates me to think about a number of aspects of medical practice and I’ll probably do individual posts about a number of them.

My summary understanding of this book would be that doctors make diagnoses by recognising patterns – that certainly seems consistent with what I think about my own practice. The key to this is the doctor-patient relationship. It’s the patient’s narrative that holds the key and the effect the patient has on the doctor colours how he or she hears that narrative.

My one criticism of this book would be that the whole focus is on the discovery of the “lesion” which is the source of the symptoms. Trouble is, as Kroenke and others have shown us, the vast majority of symptoms presented to doctors don’t come from “lesions”. I’d have liked to read Dr Groopman’s take on that huge issue.