Tuesday, December 30, 2008

How Doctors Think-Book Review

Aside from knowing the cellular changes that occur when certain genes are altered, it's amazing that I went through six years of molecular biology grad school and post doc without giving much thought to health and disease... I mean actual health and disease. i.e. what happens in humans, which is not always what happens in fruit flies. I also never gave much thought to my academic cousins, the MDs, who left me to gather dust in academia after their pre-med college requisites had been completed.

While it is relatively easy to find a link between a fruit fly's "symptoms" (or phenotype) and the genetic alteration that you yourself just induced (I do kind-of miss the weird God-like high that comes with that), it is much harder to do the same in humans. For one, human troubles are less likely to come from experimentation ;-). For another, we don't really have access as of yet to good molecular signposts for what is truly wrong biologically--doctors' tools for diagnosis (X-rays, blood work-ups, cultures, MRIs) are still pretty coarse.

Fortunately (and in contrast with flies), humans do have the gift of speech and of describing what ails them. When diagnosing a patient, doctors thus rely heavily on communication with the patient or his family members. They depend on this information to interpret the rough biological measures of what is happening at the organ/tissue level. But then there's communication and communication, and not all doctors have the skills, inclination, time, or mindset to appropriately seek information from the patient and integrate it with biological data. Even when doctors do have all the information they need, they can still make cognitive errors in determining a diagnosis or the best treatment option. Errors might come from lack of experience or from too much experience (biases for common ailments over rare ones), they might come from biases towards the patient or his/her statistical demographics, or they might even come from preferences for procedures that are financially advantageous for the doctor.

These pitfalls of medical practice and others are discussed in Jerome Groopman's book "How Doctor's Think", which is intended as a sort of patient's guide to a doctor's mind. The idea is that by recognizing the areas where doctors might fail, patients might be able to steer their physician into working at their best capacity.

I'm not sure if Dr. Groopman's book has been helpful in patient's lives but, for me, his book explained in detail the pressures on a doctor's mind. It also made me realize the difficulties associated with medical care--few of which have to do with science and technology and most of which have to do with the health care system as well as doctor's personal differences in associating with others. With such complex problems in the "real world", Groopman's book definitely made me appreciate the relative preciseness of science at "the fruit fly level" and the miles we have to go before human medicine is as precise as that.

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