In the engaging and well put together book, Jerome Groopman, the author of How Doctors Think (2008), explores the mind behind of the physician’s mind. The explicit purpose of How doctors think is to give laypeople an understanding of the medical mind so that they can participate more actively in clinical conversations and improve the care that they receive. In a style familiar to readers of his New Yorker articles, Groopman uses detailed case studies of physicians to make clear, logical, and compelling arguments. Although intended for the general public, the book offers clinicians an irresistible promise of self-understanding, and in many ways succeeds. Some of the psychological concepts that is discussed in the novel is the Idea of Cognitive psychology and how personality plays a role.
In the first few sections, Groopman explores how, when, and why diagnoses are missed by some physicians and captured by others. The book begins with a brief description of a woman with abdominal pains. Originally, she was diagnosed for years with a series of functional and mental disorders, including bulimia (Groopman, 2008). Further on a physician, beginning with careful elicitation of the patient’s story, was able to set aside those prior diagnoses to discover that she in fact had celiac disease. Later, he describes a patient given a grave prognosis only to recover, revealing the faulty and limited logic of the physicians providing care (Groopman, 2008). Cognitive psychology is used in this because cognitive psychologists are most concerned with studying how we think, perceive, remember, forget, solve problems, focus, and learn. But unlike the behaviorist school of thought that focuses only on observable behaviors, cognitive psychology studies internal mental states and processes (Cacioppo, 2016). The constant examples of certain case studies from patient and physicians explains that Groopman is using cognitive psychology to show how doctors think through their patients and everything they do to perceive
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Any professional who must assimilate and synthesize complex, ambiguous information must develop efficient means for processing data. Medical students are taught to gather a complete set of data then make an exhaustive list of possible diagnoses that are eliminated one by one until the correct one is reached. This approach is hardly practical for busy clinicians and, in fact, often can lead experts astray. More efficient approaches use pattern recognition, heuristics, and illness scripts, which provide coherent links between knowledge and experience. These cognitive shortcuts are highly personal, we each have our own internal library of facts, experiences, and procedures that help us locate a patient’s expression of distress within a diagnostic framework quickly and accurately. This personal library helps build a physician's personality which plays a major role on how doctors think through the process of helping their patients.
Groopman eloquently elaborates the dark side of these same approaches, especially when they become automatic, mindless, and as the physician persists with a single formulation in the face of disconfirming data, sees only part of a whole picture, or assumes that the most accessible data are the most important. Further on, he describes how pharmaceutical advertising exploits these cognitive tendencies. Physicians like to solve problems, and pharmaceutical companies graciously oblige by both creating problems and offering solutions. This is yet another prime example on how the physician’s personality plays a major role in the novel so we can understand how a doctor think.
Going back to the idea of the cognitive psychology, Groopman truly dives into the minds of how doctors think by takes the readers on a tour of a wide range of medical fields while jumping swiftly back-and-forth between the physician and the patient’s perspective. Most chapters open with the story of an individual patient and his doctor, whose interactions introduce us to an aspect of problem-solving in medicine. The author then further expands upon the subject in an essay form by weaving into the storytelling opinions from experts of cognitive thinking in medicine as well as evidence from recent research work on the topic (Xia, 2008). The stories, although slightly melodramatic at times with their predictable climax followed by a happily-ever-after resolution, do provide an accurate and helpful glimpse of the complex infrastructures of health care to those unfamiliar with the field. This really is a prime example of how cognitive psychology tries to build up cognitive models of the information processing that goes on inside people’s minds, including perception, attention, language, memory, thinking, and consciousness (Xia, 2008). This is just another prime example how Groopman used cognitive psychology to dive into the minds of doctors because the interviews allowed the readers to understand the mind of doctors and be able to see the perspective form the point of view of the physicians.
Dr. Groopman possesses a quite impressive ability for stripping medical facts of their jargon and rendering them accessible to laymen. Each story directs his lens onto particular “cognitive errors” in the practice of medicine, a term he uses to describe flaws in the thinking of physicians that result in misdiagnosis and/or mismanagement of illnesses. Then, deftly alternating the focus between the analysis and the story, he intertwines theory and practice to demonstrate how these mental traps can be averted. Groopman is on the right track. All clinicians should read this book. All of us can learn something. It is an easy read, engaging, and can be shared with family and friends. Hopefully it will reinforce all physicians’ efforts to understand themselves better, for the benefit of their patients and perhaps also for their own well-being.
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