How Doctors Think

I was listening to NPR today and there was a program featuring Dr. Jerome Groopman, a cancer doctor and Harvard professor who is well known for his medical writing in the New Yorker magazine. His new book is "How Doctors Think." Two interesting tidbits from the radio show (I didn't hear it all...it was during my commute and I got home before it ended.)

1. Doctors make a decision or judgment about you or your condition within 18 seconds of your arrival in the office. Then, all of their questions during the interview with you are likely to lead up to or support the conclusion they came to within those first few seconds. He spoke about how truly difficult it is to have a doctor really listen openly and evaluate what you are saying objectively.

2. Does your doctor like you? 100% of doctors polled said they would switch doctors if they perceived that their doctor didn't like them. This speaks to how powerful the personal relationship is in terms of the care you will receive.

Food for thought for everyone, and especially those (like us) with chronic conditions. It's making me realize I need to switch one physician of mine (not my GI) who I've always felt doesn't "like" me for some reason and wondered if that was a good enough reason to make a change.

I read a great book about how to be a good patient and it was about how doctors think. There was a script of how you should being each visit, re-capping some of your history and refreshing your doctors memory of who you are. Some of it was too formal for my liking but I adopted some of it and Ive had my pcp comment about me being a "model patient." I answer all her questions before she asks them. But unfortunatly, for the life of me, I can't remember the name of the book. Sorry!

I was in the ER back in 05 I have not been on any meds since 97 when I went to a bag and every time I go to the ER the doc's freak out...now the last 2 times I have gone for dehydration they end up going the whole crohns route and CT's blood and stool samples ect
the works...I tell them that it ant Crohns and its dehydration do to me having a flu that cased me to have water for a stool for the last 24 hours and I am not able to replenish the body fluid fast enough. I had this one young ER doc actually yell at me from the end of the bed that I should be on meds and I know what meds he is talking about and he know all...I said you don't have a clue what you are talking about and he should talk to my family doc and that I have more knowledge on crohn's than he could ever know. I felt this particular hospital just views people like me as a insurance money maker and they just want to slam me in a hospital room and run test on me...BTW I got my dehydration therapy that day and walked out the hospital better than when I came in and had no crohns issue or any other since then, HE WAS wrong and yes Docs don't know all and yes they run a ER like a business to make the hospital money.

 I threatened to report them to my insurance after they sent me a bill for a room I never had b/c I refused to be admitted.

Post Edited (MDdave) : 11/13/2007 8:32:20 PM (GMT-7)

I read this book this past summer just before starting med school.  I think it's a great book and it would be great if all patients and their doctors could read it. 

If you read the whole book, Dr. Groopman does, at least partly, go into WHY many physicians don't think more "outside-the-box." There are several reasons, but one of them is that docs are pressured to see more and more patients (partly because they have to pay higher malpractice insurance premiums, which is partly because more patients are bringing up frivolous lawsuits against them).

Another one is that with the explosive advancement of science and medicine, we are expected to keep up with gazillions of new pieces of information and research every single day, but medical training itself takes essentially the same amount of time it did 50 years ago.  I think people tend to ignore this extremely obvious fact.  Though I would hesitate to voluntary put myself in the position of a med student for even longer than four years, it probably wouldn't be the worst idea in the world.

I could go on and on, but my theories about the theories of medicine are probably pretty boring...although I feel pretty lucky to be able to come at this issue from both points of view!

Here in the U.S., students first earn a bachelor's degree (4 years), then an M.D. or D.O. in 4 years, do a 1-year internship, then continue with residency for an additional 2-6 years in whatever specialty we decide to pursue.  For family docs, the total post-post-graduate training (i.e., post-medical school) is 3 years; for a neurosurgeon, it's at least 7.  It's a good amount of training but, like I said, it's a LOT of material.  I wouldn't hesitate to say we've been responsible for more material in the first 10 weeks of med school than we were for probably an entire semester (maybe two) in college.

Not whining here...I chose this!  But I know that it helps me, as a patient, actually empathize with my doctor, and figure out how I can best help him help me!

An EXCELLENT book, read it several weeks ago. Many great points, though not all lay people will pick up on them. He also makes a few of the same mistakes, but has the cajones to admit his own biases..
We need more docs like this.

Matthew
I also appreciated the views different docs take based on their own branch of medicine.

I had a funny moment in the ER one time. I had a young intern, and he very seriously looked at me, with such a caring expression, and said "I can't cure you!". I looked at him, laughed, and just told him it was okay, that I wasn't looking for a cure, I just wanted some anti-nausea medicine, fluids, and to feel better. The look of relief on his face was priceless.

I always question my doctors, the medicines they put me on, and what they will do to me. It's my medical background, but it's always a good idea to find out exactly what you are taking, what it can do to you, and why your doctor believes it might help you. As Umm stated, I have an "unusual pain tolerance" as well. So my doctors and I have had to learn different pain scales to compare how I feel and what I need to combat it. Pretty much, when I say "I'm in pain"...they know I'm really in pain, and I mean it, and that I need something ASAP to kick it.

~Sway

I was in the hospital recently for a resection. On the fifth day I knew I was getting out because the surgeon had already told me. They took the IV out of my arm and I was basically just waiting to have a BM. Since I'm a smoker, I thought that it might help to smoke a few cigarettes to get my bowels moving so I put my clothes on and walked out of the hospital. I had to walk to a nearby sidewalk as no smoking is permitted on the hospital property.

When I came back, my GI was standing outside the hospital talking on his cell phone. I sort of smiled and lifted up my hand in a half wave and he looked away from me. Then he got off the phone and walked back into the hospital as if he hadn't seen me. I don't think he saw me smoking, but I guess it's possible. I think rather he didn't wish to associate with a patient outside of a doctor-patient setting. Or maybe it bothered him that I was out wandering around the hospital. I went back up to my room not long after that as I expected he was making his rounds. It seemed business as usual when he came in and didn't say anything about me leaving the hospital.

I think he's been kind of annoyed with me for awhile now because, with my job, I've had trouble sticking to appointments, though I always cancel with sufficient notice.

Thanks Sway, I thought about bringing it up when he came up to the room but thought it was best not to. And you're right, there is a good possibility he didn't recognize me in regular clothes expecting I'd be in the hospital.

It's a good thing...that means he can tell the difference between how your butt looks and your face LOL!


:)