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Everyone knows that medical school and residency are stressful for young physicians. The AMA Alliance knows that the training years can be just as challenging for the physician's spouse. Our new blog offers resources to provide specific support for partners of physicians in training, as well as assistance in finding an Alliance in your area.

We know that support for the family of medicine is most comforting when it is provided by the family of medicine.

To learn more about the Young Member Connection please view our first blog entry here.

Thursday, March 26, 2009

Introduction & Book Review

Hi all:


My name is Bea. I'm married to my high school sweetheart, J, who is a PGY-1 surgery resident in a Philadelphia hospital. Since I'm married to a doctor I'm committed to learning about how to have a successful medical marriage. In fact, I decided to start a blog on medical marriages, just so I can record things I've learned, books that have helped me, and advice that I've heard from others in the know. Through my blog I've met a group of wonderful medical spouses, including Abby, who asked that I post on here from time to time.

I'm an avid reader and I've got a whole stack of books on medical topics that I'm reading and reviewing. Below is one of my first book reviews. Hope you enjoy!


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How Doctors Think is a nicely written book that provides insight into a doctor's cognitive process and offers advice on how patients and doctors can work collaboratively to achieve a successful outcome in treating a patient.

Audience. In the early stages of his book, Groopman notes that the book is aimed at a layperson. While the book is easy to read and the medical terms and conditions are understandable to a layperson, there were several instances where I felt the book was better suited to a doctor than to a patient. More on that point below.

Organization. Groopman organizes chapters by themes and by specialty. However, this organization is difficult to discern at first glance. I've added information about chapters that deal with certain specialties. Although the chapters aren't exclusively about that specialty, a lot of the discussion centers on a specific field. The chapters are as follows:

  1. Flesh-and-Blood Decision-Making
  2. Lessons from the Heart
  3. Spinning Plates
  4. Gatekeepers (primary care physicians)
  5. A New Mother's Challenge (pediatricians)
  6. The Uncertainty of the Expert
  7. Surgery and Satisfaction (surgery)
  8. The Eye of the Beholder (radiology)
  9. Marketing, Money, and Medical Decisions
  10. In Service of the Soul (oncologists)
Each chapter is a manageable length. Generally, Groopman begins each chapter with stories from the medical field that illustrate the cognitive thought process of a doctor. The story then leads into explanations of the doctor's thought process, and concludes by telling patients how they can tap into this cognitive thought process.Ultimately, the greatest (and most practical) nuggets of information are towards the end of each chapter. For a patient who is desperate to find out how to communicate better with a doctor, I'd skip to the end of the chapter. While the entire chapter may be enlightening and entertaining, there are times when Groopman gets caught up in narrative prose and unnecessarily prolongs a valuable lesson. Groopman probably runs into this problem because he loves his profession and loves stories that illustrate his point, so I don't fault him for being a bit wordy. I just think some people may be reading this book to help with pressing issues about their health and they may want to cut to the chase. If I were the editor of this book, I would have provided a bulleted list at the end of each chapter summarizing his points. A bulleted list would take away from the story-telling, but it would be extremely helpful for the audience the book is primarily geared towards- patients with puzzling medical issues that want to problem solve more effectively with their doctor. Perhaps the most valuable chapter is the Epilogue which really delves into how a patient can ask questions effectively. Even that chapter digresses into medical stories, but the beginning of the epilogue is exceedingly helpful.

Here are some examples of his great advice. Depending on the situation, ask your doctor:

  • What's the worst thing this illness/condition could be?
  • What body parts are near where I am having my pain?
  • How often do complications occur from this surgery?

The overarching theme of the book was the play between a patient's desire to be healed, the doctor's desire to heal, and the limitations of a doctor and a patient. The doctor is only human and both doctors and patients need to accept this fact. No doctor, no matter how much practice and wisdom she has, can solve every problem. Patients need to accept this limitation but work with the doctor to achieve the best outcome, with full acceptance of the limitations presented.

Who should read this book? I'd recommend this book to patients who have encountered frustrating sessions with their doctor and would like to approach future interactions in a more satisfactory way. I'd also recommend the book to skeptics, because they may have become skeptics because of failures to communicate effectively with their doctor. But most importantly, I'd recommend this book to doctors. Groopman certainly intended to make the book manageable for a layperson, but a large part of the book is dedicated to information that would best benefit a doctor. He discusses a myriad of psychological terms related to a doctor's thought process-- things such as commission bias, satisfaction of search, attribution error, distorted pattern recognition-- all of which I'm glad I learned about, but ultimately wouldn't help me if I'm sitting across from my doctor trying to solve a medical puzzle. The reason these terms won't help me is because I can't see inside my doctor's brain, so I can't see which cognitive process he's experiencing at that moment. Only a doctor can analyze his thought process and see where he may have made an error in judgment.

Of course, the problem is, what doctor (or resident, at least) has time to read a 200+ page book? My suggestion is, if you're a doctor and you are strapped for time, go directly to the chapters that pertain to your specialty. My husband, for example, should read the surgery chapter and the one about radiology, because Groopman gives some good advice in the radiology chapter for doctors in other specialties and how they can best communicate with a radiologist.

I probably wouldn't recommend this book to someone who is in general good health, is young, and hasn't really encountered any puzzling medical condition that needs to be treated. Of course, we never know when we're going to have our body break down on us. But I have to be honest. There are a million books I'd love to read. If I weren't married to a doctor or interested in the medical field, I probably wouldn't put this book at the top of my to-read pile. If I were in my 70s, or if I had a chronic medical condition that hasn't fully been treated effectively, I definitely would put it up there. I also would put it at the top of my pile if I had an aging parent with persistent medical conditions. Finally, if you just love reading medical stories, this book has enough stories to keep you engaged.

Advice for medical spouses? The book never purports to be a guide for medical marriages, but I do think spouses of doctors can stand to benefit from reading this book. First, spouses of doctors often get the brunt of complaints about doctors from family members and friends. A doctor's spouse can politely offer this book as a solution for a patient who is frustrated with the relationship they have with their doctor. Also, the book provides a lot of great advice for physicians, but physicians likely don't have the time to read it. A spouse may glean helpful information from the book to provide to the doctor spouse when the spouse discusses instances of miscommunication with a patient. Consistent with the premise of the book, the person who has more time to devote to bettering communication channels with a doctor can use certain words to produce successful interactions. In the words of Groopman:

after writing this book, I realized that I can have another vital partner who helps improve my thinking, a partner, who may, with a few persistent and focused questions, protect me from a cascade of cognitive pitfalls that cause misguided care. That partner is present in the moment when flesh-and-blood decision-making occurs. That partner is my patient or her family member or friend who seeks to know what is in my mind, how I am thinking.

Bottom line. This was a very enriching book and I think everyone could stand to learn something from it. I can see why it has been a best seller and I do think it's a book that needed to be written. I enjoyed reading it.

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