Jerome Groopman and Atul Gawande, two Harvard University researchers, clinicians, and best-selling authors, are for my money the best medical writers around. The New Yorker’s one-two punch for a decade now, the two have set a new standard with their precise prose, command of facts, and investigative brilliance. On topics ranging from the proper care of terminal cancer patients to how the best cystic fibrosis doctors push their patients’ life spans far beyond the mean, they have certainly educated this colleague. Now, from different angles, they each go after the same crucial question: Why isn’t medical care better? And each, in turn, misses the mark.
Medical errors made headlines in 1999 when an Institute of Medicine report revealed that these mistakes cause 98,000 deaths a year. Since then, a bevy of cognitive-science studies have demonstrated how doctors jump to conclusions, overrely on quick pattern recognition, let prejudices sway them, and of course, don’t listen enough.
In his new book, How Doctors Think (Houghton Mifflin, $26), Groopman goes at the problem from the inside out, examining “what goes on in a doctor’s mind as he or she treats a patient.” His concern stems from recent studies confirming that “the majority of errors are due to flaws in physician thinking, not technical mistakes.” By acquainting laymen with the most common mental errors, he aims to give patients and their families the tools to help their doctors think and thereby prevent misdiagnoses.
Groopman sifts through representative cases for the mental blinkers, blind spots, and prejudices that lead to error. There’s the saga of a woman repeatedly misdiagnosed over 15 years with irritable bowel syndrome and psychiatric problems until a gastroenterologist detects celiac sprue—an immune assault triggered by gluten in her diet. Next is the adopted Vietnamese baby girl with severe infections: She almost gets a bone marrow transplant until her Web-scouring adoptive mother persuades doctors to repeat her immune-function tests, which all turn out to be normal.