Books

If it seems your doctor's eyes glaze over 20 seconds after you've started recounting your ailments, you're not imagining things.

Dr. Jerome Groopman, a staff writer with The New Yorker and author of the newly published book, How Doctors Think, says doctors diagnose a patient within the first 18 seconds of speaking with them.

How Doctors Think outlines how doctors often misdiagnose because of their emotions. Sometimes they view a truly sick person with many ailments simply as a complainer, Groopman writes. On the other hand, a doctor can misdiagnose a serious illness in an outwardly healthy patient because of positive feelings, he says.

Despite its criticism of the medical profession, Groopman says the book has been well received by the medical community.

"That's because misdiagnosis is a big issue in medicine," he said. "For the first time, this book helps people understand why we come to the right diagnosis, but also why we go astray. The other thing is that the worst errors in the book are my own. It's not a preachy self-righteous book. I make myself quite vulnerable."

According to Groopman, to be an effective consumer of medical services, patients need to realize there are two categories of physician thinking.

"A physician's emotions can colour his or her thinking and actions," he said. "Patients need to know how to pick up on negative and positive feelings."

"A physician's emotions can colour his or her thinking and actions."

— Dr. Jerome Groopman

It's also important for them to convey exactly what the symptoms are. Sometimes doctors make an attribution error because they may think it has to do with an existing condition, which often happens with menopausal women.

Dr. Jerome Groopman, a staff writer with The New Yorker and author of the newly published book How Doctors Think. (David Carmack)

Groopman cites the case of a woman going through menopause who felt she had explosions going through her body.

"She saw four doctors, and when she got to the fifth doctor, she told him she was high-strung and in the middle of menopause, but she felt explosions that were different and that something truly was wrong. That kind of language causes the physician to listen. It turned out she had a tumour producing adrenalin, which caused the explosion feeling."

He says if a patient genuinely feels the symptom is different from anything they've ever felt, to red flag it — ask the doctor to take it seriously, not to stereotype and make an attribution error. If you think a doctor is not listening, search out a second or third opinion.

Personal experience

Groopman himself endured poor medical advice over a three-year period when he attempted to obtain treatment for a painful wrist. The first doctor gave him a diagnosis of a condition Groopman discovered didn't exist when he checked it out on the internet. He then received four different opinions from six different surgeons.

"What I needed was someone who was thinking, not just dismissing me and saying 'I'll figure it out when I cut you open.' I needed someone who could explain to me what was wrong so that it made sense to me."

Another area that Groopman tackles in his book is the fallibility of medical tests.

In one case, doctors looked at a chest x-ray of a 60-year-old patient who was missing his left clavicle. Sixty per cent of the radiologists who looked at the scan failed to notice it.

"That's what happens when doctors make snap judgments. Radiologists also need the history of the patient to focus their attention."

Misdiagnoses are not all the fault of doctors, Groopman says. He feels physicians in the U.S. and Canada make snap diagnoses when they lack the necessary time to make a proper diagnosis.

"The system has changed, so we're working under terrible time pressure," he said. "In Boston, visits have been carved down to 12-14 minutes, new patients visits run 20-30 minutes. That makes it hard to listen and hard to think when you have a stopwatch. So doctors fall back on shortcuts in thinking."

"If you know how a doctor thinks, then you can know how a doctor goes down the wrong track, what the red flags are and how to help them think better."

— Dr. Jerome Groopman

Groopman says it's often the very last symptom that triggers the realization in the doctor's mind about what the patient is suffering from. If doctors have the opportunity to conduct longer visits, he says, they might actually hear that one thing that helps them diagnose accurately.

The answer, he says, is educating medical students and lay people.

"We should learn how to resist jumping to a snap conclusion. But the radical argument of the book is that while we educate ourselves around these thinking traps, we need to have educated patients. If you know how a doctor thinks, then you can know how a doctor goes down the wrong track, what the red flags are and how to help them think better."