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.

The most enjoyable depressing book you'll ever read

The Grass is Singing, by Doris Lessing

Well, I guess I wouldn't really say that I enjoyed this book--how can anyone really enjoy the telling of the maddeningly slow yet unmitigated disintegration of a woman and her psyche--but it was nonetheless an engrossing read.

The main character, Mary Turner, is an odd bird. The first half of her life, is an unremarkable, daze. She lives life content and complacent with her lack of goals and meaningful personal relations. The woman is almost pathological in her tendency not to leave a trace in the world, or rather, in not letting the world leave a trace in her. She never falls in love or allows anyone else to fall in love with her and she never fosters any personal desires or dreams. She lives a boring life of consistency. The author attempts to give us a psychological explanation of why she is this way--something to do with her suffering mother and her drunkard father--but it is not very convincing (at least to me). What is convincing is the sense that Mary is not a likable woman and that perhaps she is not in full possession of a sound resilient character.

Mary's reasons for marrying Dick are equally strange. She does it because she suddenly realizes that as a single woman, she is the object of people's pity. She thus moves out into the African bush, where Dick has a shabby house on the skirts of a shabby farm. From this point on the mood turns from drab to dark. Little by little, the sun, the poverty, the loneliness, the unyielding heat, and her hatred for "the natives", begin whittling Mary's character and sanity down until there is nothing left but a shriveled-up carcass of a woman and a human being. Ironically, it is a hateful act that Mary commits toward a black farm laborer that makes her start seeing him for the very first time. In her broken down state, this new vision becomes a sick obsession, and it finally explodes with tragic consequences.

Mary's life, we know, is also a parable for racism, colonialism, and white supremacy in Africa and the destructive effect they had on the individuals and its society.

So, yeah, a real pick-me-upper... But what was weird was that, while I could not identify with the characters and, in fact, rejected their weaknesses and faults, I could not put the book down. I tortured myself metro ride after metro ride with this story of a crazy white lady in crazy-white South Africa. I think this was due to Doris Lessing wonderful writing. The author creates a hypnotic psychological vortex in the hot and arid lands of the African bush and she is not afraid to take it to its ultimate conclusion.

See my Goodreads page here.