How Doctors Think by Jerome Groopman, Houghton Mifflin Company, 2007

Every now and then I read a book that resonates and results in nodding to myself while reading. That is what happened as I read How Doctors Think by Dr. Jerome Groopman, a professor of medicine at Harvard Medical School.

The book revolves around clinical scenarios that physicians contend with regularly. The goal is not to criticize doctors but to explore the common processes that affect how medical diagnoses and treatments evolve. The focus is on physicians’ cognitive and psychological attributes and how clinical decisions are sometimes based on understandable, yet fallible, reasoning.

One of the nodding episodes I had was a case Dr. Groopman describes that was the mirror image of an experience I had some years ago. A woman of Mediterranean extraction in her early 30s was referred to me. She had gone from doctor to doctor complaining of episodic headaches and concurrent bouts of anxiety. The referring neurologist said, “She recently broke up with her boyfriend and has been ‘worked up,’ but nothing has been found. I think this is all in her head. See what you think?”

In the interview, she told me she had always been well and physically active, and indeed had broken up with a boyfriend. For about eight months, she had these episodes lasting 10 to 15 minutes of “pounding headaches” and nervousness that would just stop on their own. She said they started before she broke up with her boyfriend.

The examination was unremarkable. As she sat up from the abdominal exam she said, “It is happening right now.” I listened to her heart, which was racing. Her blood pressure was 180 systolic. By the time I got an electrocardiogram, her pulse and blood pressure had normalized. When her pheochromocytoma was eventually removed, she, like Dr. Groopman’s patient, returned to normal.

Dr. Groopman eloquently helps the reader understand the recognized pitfalls in medical thinking without implying a systemic deficiency in physicians’ commitment or knowledge. He explores cognitive and psychological issues that sometimes lead even concerned and careful physicians to questionable diagnostic and therapeutic decisions.

Professional and lay readers can benefit from the wisdom in this book. I believe it should be required reading for medical trainees as part of their undergraduate and postgraduate education.

Michael Gordon is a professor of medicine at the University of Toronto.