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Book and Media Reviews
August 8, 2007

How Doctors Think

Author Affiliations

Book and Media Reviews Section Editor: John L. Zeller, MD, PhD, Contributing Editor.

JAMA. 2007;298(6):685-690. doi:10.1001/jama.298.6.688

Physicians have a long history of writing books relating to the human spirit. Few of these physicians, however, are practicing hematologists/oncologists, and so this book is of special significance in the field. The stories are familiar—the same stories that physicians (including hematologists/oncologists) face on a daily basis. This book highlights those areas of medical practice in which doctors may be caught up in cognitive distortions or communication errors resulting in poor outcomes. In effect, Groopman has compiled a compendium of altered cognitive and communication states that can result in misdiagnosis, underdiagnosis, overdiagnosis, or incorrectly communicated diagnosis. While some altered cognitive states are positive (ie, productive anxiety increasing focus on a problem), many others may appear positive but are negative. These include liking a patient too much to consider a serious disease or to recommend an invasive procedure; trusting intuition too much; diagnosing a disease because it is similar to other ones recently treated by the physician; or overlooking confusing but otherwise important clinical information. The book is filled with vignettes of patients living with the consequences of incorrect diagnoses (ie, celiac disease misdiagnosed as irritable bowel syndrome, gastric cancer misdiagnosed as reflux) or missed diagnoses (rectal abscess in a young man receiving chemotherapy for osteosarcoma). Errors of commission and omission are reviewed, as well as confirmation bias, “we sometimes see this” bias, and others. He describes common problems in communicating medical language to laypersons, eg, “your blood culture was positive but it was a contaminant” being misunderstood as “your blood is contaminated and thereby you may have venereal disease.” The author also doesn't shy away from conflict-of-interest issues, the lure of accepting pharmaceutical company enticements to use their drugs even when not appropriate, and the pharmaceutical company–driven overuse of drugs such as estrogen replacement for postmenopausal women or testosterone replacement for aging men.

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