Lay Down the Stethoscope and Listen to the Patient

Anne Dodge, an American young woman, has met almost 30 physicians over the span of 15 years until 2004. Anne, who in her 30s, has been suffering from severe pain, nausea and vomiting that come after meals. Some physicians diagnosed her case as anorexia nervosa with bulimia, an eating disorder. She has even seen endocrinologists, hematologists, epidemiologists, and psychiatrists, but her health has worsened day by day.

Some doctors advised her to eat at least 3,000 calories a day mainly in easily digestible carbohydrate-forms such as cereals. However, the nausea and vomiting continued. She was even diagnosed with irritable colon syndrome. She said to doctors that she willed herself to consume 3,000 calories, but they thought she was lying because she continued to lose weight.

In 2004, Anne saw Dr. Myron Falchuk at Beth Israel Deaconess Medical Center in Boston. She didn’t expect much from him. As with other physicians, she thought he would flip through her medical records and come up with similar remedies. Yet he was different. Dr. Falchuk asked, observed, and listened to her as if he had never seen her medical records. He was very attentive to her.

He concluded that she actually consumed 3,000 calories a day. With close examination, he determined that she was suffering from celiac disease, an autoimmune disorder that causes an allergic reaction to specific food components. Her previous doctors suggested that she consume cereals, which triggered allergic reactions. Jerome Groopman, a professor at Harvard Medical School and the author of the book, “How Doctors Think,” said through the story of Anne Dodge that at the moment doctors turn their backs on patients, they fail to become genuine doctors.

This book is about what goes on in doctors’ minds and what thought process they typically go through when they treat patients, and it teaches recommendations for them. The author is a highly regarded physician specializing in blood disorders, cancers, and AIDS.

While making a round of visits to patients along with residents, Dr. Groopman found himself disappointed at their lax attitudes towards patients. He was also disillusioned about himself since it was he who mentored them. After that, he went around the nation to look for noted doctors, listened to and observed how they think when they treat patient. He explored what process they use to pinpoint patients’ diseases, and what thoughts lead them to make flawed diagnoses. The book tells us that the most important feature in doctors’ thoughts and decision-making is their conversation with patients. In particular, he advises doctors to be free from stereotypes. Positive prejudices are also dangerous, according to him.

Pat Croskerry, a physician in charge of the emergency room at a hospital in Halifax, confessed his misdiagnosis. One day, a forest ranger who was trim and fit came to see him complaining of chest pains. After examination, Dr. Croskerry judged he had nothing to worry about, and sent him home. The next day, however, Dr. Croskerry was horrified to hear that the forest ranger was hospitalized with cardiomyopathy. Though Dr. Croskerry suspected that the patient might have had angina, he dismissed the possibility of any severe condition because the patient looked so healthy.

Negative stereotypes also bring about misdiagnoses. Dr. Donald Redelmeier of the University of Toronto was reported by an intern over a case of a patient in his 70s. The only possible disease the ragged elderly could have had, in the opinion of the doctor, was alcoholic liver cirrhosis because the intern noticed alcohol on the patient’s breath and because the patient reported that he drank a glass of rum every evening.

Dr. Redelmeier came clean about how he felt when he encountered this kind of patient. “It’s disgusting.” In an unlikely event of the elderly having another disease, Dr. Redelmeier deserted his prejudice against the old patient and conducted a series of tests. Eventually, Dr. Redelmeier discovered a rare hereditary disorder that causes lung and liver diseases. More importantly, the patient was not an alcoholic.

Like these, the book tells about reputable doctors who have made erroneous diagnoses. Their vivid accounts from their first encounters with patients to the moments of making diagnoses make readers feel like they are actually listening to the doctors themselves.

On the surface of it, the book is for doctors, but it is as much for patients and their families. Many of us may have been afraid that doctors will be inattentive or make errors. When patients and their families give doctors detailed information and try to communicate with them with genuine attitudes, doctors can be free from stereotypes and diagnose correctly, according to the author.

zeitung@donga.com