This book is available as a hardcover, a paperback, an e-book and an audiofile for those who prefer to listen to books. I consider it another survival manual as we all work with our modern health care system. Dr. Groopman has impeccable credentials as a well respected physician, researcher, teacher and author. In this book, he explores the difficult issue of doctor-patient communications. He explains that young doctors are trained to think in a goal directed manner. As a medical student and resident, I learned to get “straight to the point” and was criticized if my patient histories wandered into irrelevant areas. What determined the relevance of the information was if it contributed to the correct diagnosis and management plan. The goal of the patient encounter was to reach the correct diagnosis in as short a time as possible.
Dr. Groopman discusses the implications of the finding that on average doctors interrupt the patient’s description of their problem within the first 18 seconds of an interview. The physician interrupts with questions designed to hone in on the diagnosis suggested by what the patient says in those first seconds. There is no question that the current system struggles with both time and financial pressures to do more with less. Unfortunately, the patient has not received the same goal oriented communication training and this is the crux of the problem. The patient goes to the physician to find out what is wrong with them. They rarely present their signs and symptoms in a cogent, systematic manner.
This point resonated with me. “…at each step along the way, we see how essential it is for even the most astute doctor to doubt his thinking, to repeatedly factor into his analysis the possibility that he is wrong. We also encounter the tension between his acknowledging uncertainty and the need to take a clinical leap and act. One chapter…of the book…reports on this in my own case; I sought help from six renowned hand surgeons for an incapacitating problem and got four different opinions.” This is a growing problem nowadays as more insurance companies demand second opinions prior to authorizing a surgical or other expensive medical treatment. Parents of children with an early neurological problem face a slightly different situation. They are often faced with two or more surgical opinions and several non-surgical options proposed by members of their therapy team. Dr. Groopman proposes a path to help the patient move through all the confusing information and he gives examples of simple, effective questions to ask your physician to help avoid many of the common problems of communication that lead to delays and diagnostic errors.
The importance of this book to medical education is measured by the number of medical schools and residency programs that are adding it to their recommended or even required reading lists. Patients and families should all have a copy and it would also make a great gift for your favorite physicians and therapists.