Jewish Journal

A physician examines his profession’s blind spots

by Zackary Sholem Berger

May 17, 2007 | 8:00 pm

Dr. Jerome Groopman, M.D.

Dr. Jerome Groopman, M.D.

Jerome Groopman is a physician and clinical scientist at Harvard University, a specialist in AIDS and cancer. He's also a writer for The New Yorker, with a successful and thought-provoking series of books on such topics as the intersection of spirituality and medicine and the importance of a physician's intuition. His new book, "How Doctors Think," asks the question: Why do doctors make mistakes and how can we keep them from happening?



I've tried to make myself a better doctor. Like most medical students, I was not educated in thinking about thinking. At least I've become much more self-aware. Hopefully through the process of writing this book, I'll think better for my patients.


JG: By and large, we do a good job as doctors. We're right about 80 percent of the time -- our misdiagnosis rate is 15 percent to 20 percent, which is remarkable. But in about half of misdiagnoses, there is serious harm to the patient. My hope is that people in charge of medical education will seriously look at this and ask how can we do better in terms of educating doctors to think about their thinking and avoiding pitfalls.


They should ask, "Could this be anything else?" or "I'm worried this is something serious."

That is the genuine partnership.


JG: There's an integration of thinking and feeling; our emotions color our thought processes. In the real world, pitfalls in thinking are also influenced by our emotions. So you have to recognize feelings -- to be self-aware and know there are going to be patients that you adore. That can impair your judgment, as well. The flip side is there are patients we don't like, that we find irritating or provocative.

ZSB: Do patients have to recognize feelings, as well?

JG: It's much harder to be a patient than a doctor. Research I mention in the book shows that patients pick up accurately if doctors like them or don't like them. Patients need to defuse such a situation or open it up. There are patients who have said to me, "I can feel how devoted you are to me. I don't want you to hold back." If [on the other hand] you feel like the doctor's irritating you, as I experienced myself as a patient, that's a red flag.

ZSB: What does the Jewish tradition mean to you?

JG: I feel its importance very deeply. There is room in it for doubt and skepticism and questioning, not a sense of infallibility. There's also extraordinary psychological insight with regard to motivation and character. For example, Maimonides talks about magical thinking, and the Torah talks about not believing in sorcery -- often patients do have magical thinking, believing that they will be saved.

ZSB: Doctors, too -- magical thinking guards us against admitting our ignorance.


ZSB: Do you feel recourse to spirituality, to God?

JG: As much as I wish there were miracles -- boom, my hand's fixed -- those are fantasies. What Judaism teaches us is the knowledge that we're created with reservoirs of resilience. We are created with the capacity of wisdom, which means judgment -- not just knowledge, but the ability to assess and weigh that knowledge to make choices. Very integral in Judaism is the sense of hope. There is capacity to improve. What it takes is drawing on gifts of science with mobilization of the spirit.

ZSB: How do you mobilize the patient's spirit?


ZSB: Is the spirituality you've talked about just a fancy name for trying to inject religion?

JG: I don't think you need to be religious to have a sense of awe or to look within yourself or around you for nonreligious sources of strength, whether they be family, friends or therapists. I care for many people who are atheist and agnostic, and I certainly don't have the hubris of imposing any religious sensibility on them. My job as a physician is to help them find that core of strength and focus.


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