To try and jog an ER physician – or any physician – into thinking widely about your problem, you cans ask “What is the worst thing this can be?” This can be helpful if the doctor doesn’t like you (doctors sometimes don’t like sick people they can’t easily diagnose, noncompliant people, or people whom they don’t like for mysterious reasons), or is fixated on a particular diagnosis. Groopman goes through the causes of misdiagnosis, and comes up with practical you (or those acting on your behalf) can ask to help your doctor come up with the right diagnosis. While any careful reader of ÆGIS would have made a correct diagnosis on page two of the book (And no, we are not cunning diagnosticians: We happened to discuss it briefly in the March issue, and know about it only because we have a friend who suffers from it) it took the patient fifteen years to find a doctor who would make the correct diagnosis, on page fifteen, of celiac disease. The book begins with a puzzling case of a woman who had been wasting away for the fifteen years of her treatment. Jerome Groopman’s book, How Doctors Think, is designed to help patients help their doctors come to the right diagnosis. By medical factors we mean either medical mistakes (looking at the x-ray backward or prescribing the wrong dose of a prescription medicine) or incorrect diagnosis (which accounts for about 80 percent of the cases in question), or avoidable drug interactions (which account for a significant percentage of hospitalizations). There is some question as to exactly how many people die each year due to unfortunate medical factors, but we recall having read that it approached 210,000. His message to us was firstly that we should look for a medical cause before accepting a psychological diagnosis, and secondly that when someone got sick, it was important to do our homework in helping the doctor reach an appropriate diagnosis and treatment. In every case he found an underlying physical cause for the mis-labeled psychological diagnosis, and was able to help the victim, er, patient, be healed. When we were in graduate school, we took a class with a clinical psychologist who spent a lot of time discussing cases in which he had been brought in to do second-opinion psychological evaluations.

How doctors think by jerome groopman md