How Doctors Think

By Jerome Groopman
I can't recall how I heard about this book. But read it, you won't be sorry. Recently, I had some health issues and came up against my usual wall of frustration with the health care system. Here's how it goes...
1. You are in excruciating pain and suspect you have a kidney stone. You drag your ass to Yale Health Services in the middle of the night. It should be noted I am not a pain wuss by any means. I lived life with a partially blocked intestine for a year and a half for Christ's sake.
2. A half-awake resident gives you no diagnosis and sends you home with some pain killers. She gives you paper work to bring to the lab the next day for blood work and tells you to stop by radiology for an ultrasound.
3. Next day (Tuesday) you go to the lab, you give some blood. You stop by radiology and make an appointment, the soonest you can get is two mornings from now. (Thursday)
4. You dutifully drink your water and have your ultrasound. You ask who you can call to get the results. The tech tells you to call your PCP. The problem here is I don't have a PCP because she left months ago to teach at the med school. (Primary Care Physician)
5. The next day (Friday) is spent calling around and getting transferred to various people while trying to track down results.
6. Someone (A nurse? Maybe?) finally calls you back and tells you everything is negative. You express that you are still having twinges of pain and should you be concerned about this? Should you in fact, see a doctor in the not too distant future? "Umm...sure?" So you get an appointment for the next week.
7. Next week (Monday) you see the doctor. He suspects that there may have been a kidney stone but of course because no tests were done at the time of the actual excruciating pain it's hard to tell. For sure you likely have arthritis in your hips from the Crohn's Disease. The doctor tells you if the pain comes back to call and he will do a CAT scan immediately, but why go through the radiation exposure if it's not necessary. You ask this man to please, please, please be your doctor. He is nice, he is smart, he listens, he knows his way around Crohn's, and he has admired your knitting you brought with you into the waiting room.
8. You still have the occasional twinges of pain but nothing major. You check out How Doctors Think by Jerome Groopman and read it in three days.
9. A few days later (Friday) you are finishing up at work, untangling a ball of yarn on the couch in your office and you have a stabbing pain in your bladder and practicality pee yourself. You hobble to the bathroom, urinate and lo and behold, a stone! Maybe...wait... that could be dirt? Or maybe a stone? At any rate I am not sticking my hand into the toilet at work as I know how often it is cleaned. (Which is to say never.)
10. Upon reflection you decide not to call the doctor. He will only be disappointed you did not retrieve the maybe- stone from the toilet. Besides, other than the arthritis, you feel fine.

Now it should be said I do have really good health care. I am very lucky to work at a University with a billion-million dollar endowment and it's own internal medical system. All the health care is paid for and I don't need to worry about my insurance denying me a procedure because it costs too much. I want a CAT scan? Step right up! We've got like 8 of 'em that we own, so no waiting. If you needed a transplant, the biggest obstacle would be getting the organ. There would be a line of doctors and med students rearing to transplant. I am very, very fortunate and suspect that I could never leave this job.
However, for all the money falling out of Uncle Yale's ass the two biggest issues I have with medicine are time and the doctors themselves. I had these issues at the craptastic Salem Clinic, so I know these are equal opportunity problems.
The issue of time: Note that it took 10 steps to get from excruciating pain to passing a stone. And that it is still a-maybe I passed a stone. My biggest gripe has always been the time it takes from experiencing pain to seeing a doctor and that said pain or problem can go away in the interim.
The issue of the Doctor: or my point and do I have one? How Doctors Think brilliantly explains how doctors are trained to diagnose a patient. It also brilliantly explains what the hell to do about it when you feel like you are not getting the proper diagnosis or treatment. The main device in explaining these quandaries is the experiences that Dr. Groopman has had personally and with his patients, and even with some random people he just knows. I was particularly comforted that Dr. G had to see 5 (5!) different specialists to get the proper diagnosis and treatment for a chronic wrist pain. One of said specialists suggested an invasive exploratory surgery and that he would just "figure it out when he got in there." Excuse me? WTF?!
Dr. G's style is completely accessible, with only a few little sections of medical jargon. The fact that it is peppered with personal experiences makes it even more interesting.

From this book I learned the most important things in dealing with the Doctor are:
1. Like your Doctor. If you do not like your doctor, transfer to another immediately. Dislike breeds distrust. Twice I have had doctors criticize things about my life that are none of their business. I did not go back to see either one. First impressions with Doctors are the same as anybody else. If you don't like them immediately, chances are you won't ever like them at all. Just because they have a medical degree doesn't mean they are not an asshole.
2. Make sure your Doctor listens to you. I can't tell you the number of times I've been listing off symptoms and the doctor has been nodding aimlessly, not making eye contact, and "hmm"-ing vaguely. Said doctors usually made a diagnosis from previous charts and never really focused on what was happening in the present. This kind of attitude is how I got to a place where my intestine perforated. It is always helpful to make notes before the appointment, refer to said notes so you don't get off topic, and never leave until you are satisfied.
*It is very possible that the doctor is not listening because he/she has a legitimate issue on his/her mind. It is also perfectly OK to point this out. "You seem a little distracted. Should we reschedule for another time when you can be more focused?" Sure it would be a pain to reschedule, but I would rather have undivided attention later, than distraction now. I had an appointment once where the doctor had clearly just come from a very distressing moment. Subsequently I felt blown off because it was clear she wasn't listening. I wish I had said something then, because I just ended up making an appointment with someone else anyway.
3. Ask questions that will lead you both to the correct answer. If you feel like your appointment is giving you unsatisfactory answers, then ask more questions. "Could it be ___? If not, why?" Again, if you can make a list of questions before the appointment and refer to it.