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Physician, Heal Thy Profession: Dr. Jerome Groopman

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The Bostonian has credentials like hypochondriacs have symptoms.

He holds the posts of Dina and Raphael Recanati Chair of Medicine at the Harvard Medical School and is the chief of experimental medicine at Boston‘s Beth Israel Deaconess Medical Center. The 55-year-old is also a staff writer at The New Yorker, and spent much of his career researching the basic mechanisms of cancer and AIDS. In his spare time, he writes books such as “The Measure of Our Days” and “Second Opinions,” which formed the basis of the ABC-TV series “Gideon’s Crossing.”

Not content to rest on his (many) laurels, Groopman has decided to peer into the belly of his own field with his newest book, “How Doctors Think.” Call it “sick lit,” because it tells the stories of countless ailing people and how doctors misread their often unconventional symptoms.

Groopman interviewed dozens of doctors about why they made wrong decisions and misdiagnoses; he also does some serious self-examination, recounting his own shortcomings. Being a doctor, Groopman unsurprisingly offers healthy doses of viable solutions, such as advising patients to communicate better and warning doctors and technicians not to rely too much on technology. There’s also a harrowing recount of his own ordeal in trying to get a correct diagnosis for his mysterious hand ailment.

How Doctors Think” spent 12 on the New York Times Best Seller list and was given high marks in a New York Times review by Michael Crichton for being “elegant [and] tough-minded,” as well as “direct and honest.”

The book is billed as being the first of its kind to “describe in detail the warning signs of erroneous medical thinking,” and Groopman will be addressing such things locally at a Monday talk presented jointly by the Sixth and I Synagogue and Politics & Prose.

Express caught up with the good doctor in between appointments.

» EXPRESS: The book seems equally directed at doctors and lay people. Were they both the intended audience?
» GROOPMAN: Yes. I think the primary reader was seen as being the lay audience. But it clearly was meant to include healthcare professionals as well.

» EXPRESS: Have you gotten any negative feedback from doctors that you’re perhaps eroding patients’ confidence in the medical field?
» GROOPMAN: The response has been overwhelmingly positive — almost no negative feedback along those lines. And I think there are several reasons for that. The first is that I highlight my own mistakes in thinking, so the book isn’t preachy or self-righteous. The second is I think physicians realize misdiagnosis is a huge problem and has not been addressed in an organized way. Almost all of the focus on patient safety is around technical, procedural things. The vast majority of problems have to do with misdiagnosis, and most health care providers want to get it right. They want to do a good job. So the book offers the opportunity to understand why we succeed or fail in our thinking, and what we might be able to do about it. So it’s been very positive. On [Nov. 4] I’m addressing the American Association of Medical Colleges, which is meeting in Washington, and these are all the deans and medical educators from the United States and North America. And the book is the subject. I was invited to present it. So they’re interested to incorporate it into medical teaching.

» EXPRESS: Your chapter on “A New Mother’s Challenge” tells of an adoptive mother whose resolve pushed a doctor into re-evaluating his diagnosis of her child, who was thought to have an immunodeficiency — the problem turned out to be a nutritional deficiency. How common is this?
» GROOPMAN: I don’t have actual statistics. But what I would say is I received an e-mail from another outstanding pediatric hospital — from an immunologist there — who said that they had had an identical situation, and that it was only the parents’ persisting [because things didn’t quite fit into a typical known clinical problem] that they came up with what they thought was also a nutritional deficiency. But I think that the principle there is that once as a physician you get deeply anchored into a diagnosis, it’s really hard to let go. And a patient or family member or friend can press with the kinds of questions or issues that will help you rethink it.

» EXPRESS: One of your chapters looks critically at pharmaceutical companies that “medicalize” things that are natural, like aging and menopause. Do you see this getting worse or is everyone getting hip to this?
» GROOPMAN: That’s a good question. My expectation is that it will get worse before it gets better. Because society really has a mindset that there are going to be quick chemical fixes for all sorts of natural and very complicated issues like aging. The “fountain of youth” myth is very powerful in society. To some degree, it’s also medicine over-promising. You see all of these articles saying we’re going to unravel how the brain works and that means you’re going to be able to eradicate shyness, or some other trait, which is just on the spectrum of behavior. So I think there will be more exploitation of this. And, unfortunately, I think it’s going to take a lot of work to resist it.

» EXPRESS: You mention that technology can be detrimental to a doctor-patient relationship, because often the doctor will concentrate on typing data into his laptop computer instead of observing the patient. How can this situation be rectified?
» GROOPMAN: I think that there needs to be clear training and clear instruction given to physicians that when you communicate with a patient that [communication] is really integral to figuring out what’s wrong with them — and also forging the kind of human bond which is what we all seek in care. And that, yes, you’re being pulled with electronic medical records and all of these templates a lot of which is formatted to facilitate insurance billing. There’s all this boilerplate language now which is all really triggers to make sure that you maximize the reimbursement from the visit. But I think that there has to be an explicit statement to doctors in training as well as established physicians that this is not how people should be cared for. Having one eye on the computer screen and one eye on the clock is not the way I would want to be cared for.

» EXPRESS: In the chapter “Lessons From the Heart” you write about doctors making judgments based on patients’ appearances. I want to give you an example of this: When I was 16, I was hospitalized because of a chronic illness, but doctors who saw me in the ICU kept saying, “Well, you look fine.” How would you advise a patient to respond to that?
» GROOPMAN: The answer is, “I may look fine but I’m really not fine.” The more you can do to dispel a stereotype and help the doctor unhinge from a stereotype the better it will be. So the doctor doesn’t make a so-called attribution error.

» EXPRESS: Have there been any surprising responses to the book?
» GROOPMAN: I’ve been flooded with stories from families and patients and other doctors [about] the stereotypes doctors have about old age. I got numerous e-mails from people in their 70s and 80s who had medical problems that were just dismissed as being, “Well, it’s old age. The reason you’re losing your memory is old age. The reason you’re tired and you can’t walk up the stairs is old age.” Old age is not a diagnosis. And one person turned out to have a pituitary tumor. One person had no thyroid hormone, which is why they were losing their memory. Another one had a muscle disease, which is why they can’t walk up the stairs.

The other [response] has been about when there are persistent problems with kids. I had three stories sent to me about kids whose headaches that went on for months were attributed to stress. Everything in the society now is stress. And they of course turned out to have brain tumors. Most kids with headaches don’t have brain tumors. But when the headache is lasting five or six months, to keep hammering on stress and tell the parents it’s not worth getting a brain scan is a mistake.

» EXPRESS: What was your thinking behind including passages on religion and spirituality in the book?
» GROOPMAN: Religion is a very powerful element in people’s psychology and an important one with regard to resilience and sometimes decision making. So I think it needs to be addressed and it needs to be harnessed, often for the good of the patient in terms of making prudent decisions — and also knowing what your values are and goals and how you see living your life. That’s particularly true in the chapter “In Service of the Soul,” where people with incurable diseases make different choices which aren’t strictly clinical. And in terms of the mother in the Rachel Stein chapter [“A New Mother’s Challenge"], she was able to maintain her equilibrium through an unbelievable harrowing time through prayer. It wasn’t that she thought magically God was going to open the heavens and retrieve her adopted daughter. It was more that saying psalms gave her a sense of strength and clarity of thought.

» Sixth & I Synagogue, 600 I St. NW; Mon., 7 p.m., $6 general or receive two free tickets with the purchase of a book; 202-364-1919. (Gallery Place-Chinatown)

Written by Express contributor Tony Sclafani
Photos courtesy of David Carmack Photography