How Doctors Think

[Berkshire Road]

Has anyone else finished reading this? Would love to start a discussin re: the book and how it relates to us.

[ihurttoo]

I ordered my copy the other day, just waiting for it to come. Cant wait to read it! :) I know that Kara has read it or is currently reading it. It sounds like it is a great book! I take it that you liked it too?

[Kara29]

I wrote a post on this topic. Yes I did read the book. I have a LOT of thoughts on it and would be happy to talk about them. I've been thinking about a few things over and over again. Of course I know this is just one Doctor and his opinons. I wish more Doctors thought like Dr. Groopman. It would make our lives so much easier.

The following quotes were taken from the book "How Doctors Think" by Gerome Groopman, M.D. They are about what patients could ask thier doctors in order to reach some answers to what is happening.

Page 76

"What body parts are near where I am having my symptoms?"

"If the pain is new, on top of that long-standing problem, what body part might be causing the symptom." What we say to a physician, and how we say it, sculpts his thinking. That includes not only our answers, but our questions."

Also page 260

"Tell me the story again as is I've never heard it-what you felt, how it happened, when it happend. If he doesn't ask you to do this, then you can offer to retell your story. Telling the story afresh can help you recall a vital bit of information that you fogot. Telling the story again may help the physician register some clue that was, in fact, said the first time but was overlooked or thought unimportant. This will promot him to look in new directions for answers."

I was kind of hoping that this Doctor would have a summarized list of questions that we could ask our doctors. I read up until the very last sentance. I was going to compile a list of questions that we can ask our doctors after reading the whole thing, but these are the only quotes with questions that I came up with in the end.

Do you have any others? Maybe we can all come up with some things to take from this book to help us with our doctors.




Kara

[Berkshire Road]

Aw, go ahead Kara, you were the one who read it first! How about this: Who do you think needs to read this book more, doctors or patients? And why?

[ihurttoo]

I wrote a post on this topic. Yes I did read the book. I have a LOT of thoughts on it and would be happy to talk about them. I am scared to go first..........

Kara
Come on! Talk! I am dying to get my copy and am interested in what it says! I know others want to know too! Plus, what did you guys think about it?

[humpieumpumkin]

I would love to know what my doctors are thinking...I'm sure "she is a headcase" is one of those thoughts...:rolleyes:

Erika:hi:

[Berkshire Road]

Yeah -- that's pretty much what the book says, actually.

[Trishann]

That would be great to know how to approach your doctor and ask the right questions? I am so lame at this thing. Please bring the ?, and make a list.

Sending hugs, Trishann

[jen74]

I read the book, and it is really good. It has a bunch of stories in it about how so many doctors have made careless mistakes when it comes to having good judgment when diagnosing an illness.
Also, I know that I was reading an article about how doctors perceive their paients as physcosomatic when they bring a list of questions with them to the the doctors appointment.
I think this is wrong on the doctors part, I think brining a list is a good thing so you remember everything you need to ask the doctor.
This book is a good read. It really describes how alot of doctors think and how they judge their patients.
Jen

[green_the_fish]

Also, I know that I was reading an article about how doctors perceive their paients as physcosomatic when they bring a list of questions with them to the the doctors appointment.

Oh, wow... I always heard you were supposed to go in there with a list, so you wouldn't forget anything! Does it say anything about why they always accuse us of having somatoform disorders? It is because saying "you are a hypochondriac; therapy is the cure" sounds better than "I'm sorry, I have no idea how to help you?" Do medical schools just train doctors to call people out as psychosomatic like that, if they have nothing that immediately appears to be wrong?

[Berkshire Road]

Um, basically, I think people come out of med school believing that they now know everything there is to know about the human body and what can go wrong with it. And of course, they don't, because not everything about the human body is even known at all yet! So, I think they do get frustrated and blame the patients when they can't find an answer. Not all doctors, certainly. But a lot of them.

I have three doctors among my siblings and siblings-in-law (three medical doctors, that is; everyone is a doctor of something in this family, LOL), and one of them is just such a stereotypical, "I know all things," kind of guy; he actually told me that no doctor would have accused me of being a drug addict unless there were substantial underlying reasons to believe that. I nearly throttled him... Fortunately, he is a radiologist and doesn't have all that much patient contact. The other two are family practice docs who work in the Indian Health Service is Taos, NM, and they take their patients very seriously and have a very holistic view of human health.

So, what I mean is there is no "one size fits all" description of how all doctors think, but Groopman's book does a good job describing a few different types of thinking that doctors use. Unfortunately, I think doctors need to read this book more than patients do; the doctors are the ones with the problem. But still, Greenie, I'd give it a go if I were you. Your library probably has it and it's a fairly quick read. You may not be able to change your doctor's approach, but you may at least get some insight into where he or she is coming from.

Any other opinions?

We ought to start a book-a-month club on here.

[Kara29]

When I went to my appointment today, I used a few of the suggestions Dr. G had with my Doctor and it was the most interesting visit I've had with a Doctor in many years. I think I had him scratching his head because he didn't see any of it coming.

I used this today: "Tell me the story again as is I've never heard it-what you felt, how it happened, when it happend. If he doesn't ask you to do this, then you can offer to retell your story. Telling the story afresh can help you recall a vital bit of information that you fogot. Telling the story again may help the physician register some clue that was, in fact, said the first time but was overlooked or thought unimportant. This will promot him to look in new directions for answers."

I told him my story over again even though I know he did not want to hear it but he heard something that I said today that changed the WHOLE Picture and saved me from a very serious operation. I also saved 6 months of waiting for a minor surgery.

I'd love to read more books about this and find more things to bring to my Doctors appointments.

I love your photos Carolyn. You have a BEAUTIFUL family!!

Kara

[Berkshire Road]

Oh -- why isn't there a blushing smilie? About those pictures -- thank you, Kara. Amy made me put them up... Jack and I feel profoundly fortunate to have our daughter (and our two rescued mutts, of course).

So, wow, you posted about the doctor's appt. but you didn't mention that you used Dr. Groopman's suggestions. That is so cool. I wish I had had the book eleven years ago when I started out on my journey to IC diagnosis. I bet you wish you'd had it back at the beginning, too. Maybe it would have saved us both some heartache.

Still, I really want to send copies of it out to our physician siblings. And I think it should be required reading for med students. I maintain that doctors need to read this more than patients do. But maybe patients can benefit not only in the way that you did, but in another way -- they can see that doctors are just people, fallible people, that they have a right to question. I see too many doctors and patients falling into this pattern of interaction, where the doctor doesn't explain himself and the patient feels stupid asking questions. Or the doctor makes assumptions, and the patient doesn't feel able to correct him.

I have really great, easy-going relationships with my two main doctors now, but it just took so long to find someone to take me seriously. And I think being female, and also having looked somewhat younger than I was for a long time, did not help my situation. Doctors talked down to me. They still do, when I have to see someone new. I feel like I always have to bring my husband or father with me, and I always have to inform the doctor that I am as well educated as he is and it's okay to use words with two or more syllables. And this is so wrong. It shouldn't matter if I'm married or not, educated or less so, everyone is entitled to be taken seriously and treated with respect, regarding our own health especially.

What do you guys think? Do we, as IC'ers, have a skewed view of the medical profession? Or is this really pretty pervasive? And what can be done about it?

So, what are we reading for May? :)

[Berkshire Road]

Kara -- I didn't come up with much of anything either. At least you were able to employ something from the book to some effect! I keep saying I think doctors need to read it more than patients, bc. I think that is the point he is making. It's his basic thesis, that some doctors don't listen well.

From the Introduction alone "...the sickest patients are the least liked by doctors, and very sick people sense this disaffection. ... Some doctors are averse to the very ill ... have deep feelings of failure when dealing with diseases that resist even the best therapy ... so they stop trying." (p.19). And, "...emotion can blur a doctor's ability to listen and think. Physicians who dislike their patients regularly cut them off...and fix on a convenient diagnosis and treatment. The doctor becomes increasingly convinced of the truth of his misjudgment... he becomes wedded to his distorted conclusion." (p.25)

So, what are we supposed to take away from that? Or do about it? Doctors tend to dislike patients who have complex problems, and then bc. they dislike us, they do a bad job treating us. I don't know about you, but I've certainly spent time in doctors' offices feeling completely powerless, knowing that the doctor was way off-base, but having no way to get him to change his thinking. And then if you try to go to a different doctor, hoping he'll have a different take, you get looked at with suspicion because you're "doctor shopping." So, I don't know, I really don't know. I guess maybe I see why things are the way they are, now, but I didn't take away much about how to deal with it.

I guess I sound a little sour. If anyone else has been reading this and can give us a more positive take on it, PLEASE chime in!

[Briza]

I'm planning to read this book, and Kara, that's great that you were able take some of what you learned from it and use it to your advantage. I've learned a lot here on ICN, too, over the years, that has helped me so much in learning how to work with doctors to MY advantage. When I first started having symptoms I was not a very nice patient, very emotional, to the drs who told me it was all in my head, had no idea what was wrong with me, because they didn't SEE anything wrong. I had NO idea what was going on, or how to handle it, so I think anything that gives ANY insight into what's going on in the dr's mind is good!

Green, I almost always have my list in hand, especially when seeing a new dr. Brief, summarized, and to the point, and the first time I did that, was the first time a dr took me seriously, and actually had some possible reasons for my pain...endo or IC.

And Carolyn, I see where you're coming from, too. I'll need to read the book to give valid opinions, but I have struggled through those situations also, and have learned that it is especially important that first visit, with list in hand, to take a good look into the dr's eyes and watch the clock to see how much time they spend with you, and ask the dr some questions about the patients they treat, what they specialize in, what treatments they offer, have they treated patients with IC, VV, PFD? General questions at first, and then I put my two cents in....Ok, you say you have treated patients with IC or at least know something about the condition now Dr. X, tell ME what YOU know, what is standard IC protocol treatment? I have some input for you, so what do you think about this med or this treatment? What do you expect each of these treatments/meds to do for me? Etc....
When I go to my regular GP,I usually see a NP instead of my GP, and even a psychiatrist a few months ago, and I have learned to be firm with them, especially when comments are made about pain meds and addiction or all the meds for IC, VV, and PFD I already have that are mostly rxd by my gyn...I let them know that I am very well read regarding IC and my other conditions, because that's what I have and so I have specialized in it, and and though I'm not a NP, PA, or GP, I know that they did NOT specialize in my conditions in med/nursing school. When they make snide remarks regarding pain meds or anxiety meds, I tell them how long I fought and how long I suffered before I was rxd ANYTHING for my symptoms and pain, and that I would never abuse my meds because they are my lifeline and that if there's a problem with that, then that topic is not open for discussion, unless the dr or NP is willing to listen to me and work with me on what meds or treatments I will or will not try. I have learned to try to read the dr, and also how to take what they are offering to help sometimes, even if it's not really what I feel is best for me, and also how to tell them if you can't or won't help me with this, then I won't be coming back, instead of the other way around. I feel more in control that way. And I've had to do this while trying not to become emotional, but sometimes that doesn't always work, and I've left crying from many a 1st dr's visit.
But when you're first starting out on the dx search, often you don't have the skills to ask the right questions, don't even know what questions to ask, or responses to give, how to "manage" your doctor, how to say, "I'm not coming back because I need help and I'm not getting it here." So, Carolyn, I don't know if all that is something you feel should have been covered in this book, but I do know that it just takes time, experience, research, and asking many questions to get to the point where you do have good reliable relationships with your doctors and also feel the right to have input on any med or treatment. Maybe that's a whole 'nother book that needs to be written. I will admit that I was very naive about doctors when my symptoms started.

[ihurttoo]

I was just reading this thread, and all of your posts, thinking, "What incredibly smart women all of you are! It is no wonder that alot of Drs. are intimidated by patients like you all who are so intelligent, well-read, eloquent, and avid researchers!" I think it is b/c they know you guys know you are stuff and could call them out on things if they dont know what they are doing. I think alot of Drs. just want those meek and mild patients that think all Drs. know everything. When they come across a pt that knows her stuff, they just freak! :)

Remember back in high school, how there could be a smart girl who was also pretty, but nobody asked her out. Then, there'd be the dumb but pretty girl who was asked out all the time? Maybe it is sort of the same thing here. They dont want to be around someone that is smart, b/c then they may realize that they arent as smart as they thought they were, (and we know that anyone who spent all those years in school takes alot of pride in their intelligence! :))

Not saying any of you guys should change! NO! NO! NO! You all are perfect just like you are, (and I am not just saying that b/c I am friends with all of you!:wink:) The only change to be made is to find different Drs. who arent intimidated by your brains. :)

[Kara29]

Dr. Jerome Groopman also wrote a book called Second Opinions. I'd like to read something by someone else.

I'm ready when you all are for the next read. I'm sure there are other books about this topic.

Kara

[Berkshire Road]

If the topic is, communications between patients and doctors, here are a few possibilities. These are all on or close to this topic, all well-reviewed, and all available at Amazon. I'm posting the links, so you guys will have something to go by besides the titles. I would happily read any or all of these, so maybe Kara or someone else would like to make a choice.

Or, if anyone has an idea of their own, not from my list, feel free to propose that too!

http://www.amazon.com/As-Live-Breathe-Notes-Patient-Doctor/dp/0865476691/ref=sr_1_7/002-4619388-8920036?ie=UTF8&s=books&qid=1177878907&sr=1-7
http://www.amazon.com/What-Your-Doctor-Really-Thinks/dp/0888822154/ref=sr_1_18/002-4619388-8920036?ie=UTF8&s=books&qid=1177878907&sr=1-18
http://www.amazon.com/Talking-Doctors-David-Newman/dp/0881634468/ref=sr_1_21/002-4619388-8920036?ie=UTF8&s=books&qid=1177878907&sr=1-21
http://www.amazon.com/Bedside-Manners-Reflections-Intimate-Encounters/dp/1400080517/ref=pd_sxp_grid_pt_1_1/002-4619388-8920036

[Berkshire Road]

BTW, Amy, knock that off!! It's sweet how you always think so well of your friends, but considering the number of doctors I've seen who treated me like a complete moron, I seriously doubt that they are overwhelmed or intimidated by me, LOL. :headbang: It's more like, they prefer patients who fit neatly into categories, and become very frustrated if they don't have the answer to your problem. So, as Dr. Groopman says, some doctors take this frustration out on their patients.

When you read it, please chime in with your thoughts as well. I know I am eager to hear what you take away from it, and the others probably are as well (and don't even think about using that "intimidating intelligence" nonsense again, girlfriend, or I'll have to come out to KY and smack you upside the head! :))

[Billsbaby]

well ladies,i am one of those people with a book stuck under their nose all the time(well when i am not being a mommy and wifey!)so i would love to join in on this reading adventure.i don't know about anyone else,but i would like to read the one on bedside manners,that carolyn was talking about.but i will actually read any of them.just let me know and i will order the book and let everyone know when i get it.jamie

[ihurttoo]

Count me in on the book club too! Like Jaimie, just tell me what and when and I will get my copy and start reading too! Great idea!

[Berkshire Road]

OK, Beside Manners it is! Here is the link for the book on Amazon.

http://www.amazon.com/Bedside-Manner...619388-8920036

Naturally you can buy it wherever you like, but you can get the author's name and ISBN from Amazon in any case.

I'm ordering my copy today... everyone is welcome to join in!