February 11, 2009 5:11 PM

How Doctors Think Can Affect Diagnoses

By
Melissa McNamara
(CBS)  Mary Harding is in the ICU with hypertension and fluid in her lungs and a nervous "next of kin."

Luckily, Mary is a mannequin — part of an exercise designed to make doctors think. That's something Dr. Jerome Groopman says they don't do enough, CBS Evening News anchor Katie Couric reports.

"I think it's time for a national conversation. Fifteen to 20 percent of all people are misdiagnosed in the United States," Groopman says. "In half of those cases it causes serious harm — and sometimes death."

A professor at Harvard Medical School, Groopman is trying to reduce those numbers with a new book, "How Doctors Think." In it, he spills some of the dirty little secrets of doctors and what dictates their diagnoses.

Read An Excerpt Of "How Doctors" Think"
"One of my misdiagnoses was a woman who I found irritating," Groopman says. "And we all have people that irritate us. She was complaining of discomfort under the center of her chest. And I basically closed my mind. I gave her antacids and stopped thinking. And it turned out that she had a tear in the aorta; the major vessel that leaves the heart."

Groopman admits that patient died.

"If the doctor doesn't like you, he or she closes their mind off. It's a set-up for misdiagnosis," Groopman says.

Doctors not only bring their personal feelings to the exam room, Groopman says, they carry around plenty of preconceived notions in their doctor's bags, too.

"Patients need to tell the doctor, 'Don't stereotype me,'" Groopman says.

Leslie Bovenzi, 44, is a mother of three who went to her doctor with persistent diarrhea and fatigue. After a series of tests, she was told, "It must be stress; it must be your inability to deal with raising your family and the stresses that come with that."

It was three years before it was discovered she had a cancerous tumor the size of a baseball in her small intestine.

"The most common stereotypes occur in women who are entering middle age and their symptoms are attributed — snap judgment — to stress, anxiety or menopause," Groopman says.

So his prescription for patients? He says, turn the tables and question your doctor.

"A patient can say, 'What else could it be?' especially if it's not getting better. Or, 'Could two things be going on at the same time?'," Groopman recommends.

Excerpts from Dr. Groopman's interview with CBS Evening News anchor Katie Couric:








He adds that you should never be afraid to tell your doctor what's worrying you the most. "Then the doctor becomes more sensitive to what the person is feeling about his or her body," Groopman says.

But there are orders for his fellow doctors, too. He hopes his book will make them change the way they see their patients — and themselves.

"We need, as doctors, to think better in an open way — to listen more deeply and to really change the way we make diagnoses," Groopman says.



Do you have a general question for Dr. Groopman? If you want general advice — not a specific diagnosis — e-mail us your question. We will post some of the answers next week.

Click here to read Dr. Groopman's articles.

•To read an excerpt of "How Doctors Think," click here.

Copyright 2009 CBS. All rights reserved.
Add a Comment See all 20 Comments
by SatM October 10, 2010 12:17 PM EDT
Dr.Groopman has done a great job of writing his experiences and thoughts.
"What Else Could it be? is a great question--butvery few DOCTORs are going to say-"I don't Know".
We had this experience in 80's with a Dermatologist and then in 2009 with a relative. WE DID ASK--"What else Could it be?
CHANGING DOCTOR-- worked--SO CHANGE DOCTOR-or DOCTORS.
But how do you find the doctor who knows or is committed to knowing?
1) Look for doctor with "Research mind--or OUT of BOX thinker".
2) Fortunately Internet--or GOOGLE was not available in 80's--but it is available now--where you can search for the Best Doctor who writes articles or writes about NEW RESEARCH or NEW TREATMENTS.
3) Look for a doctor--not beholden to INSURANCE co. rules about testing. In 2009,ER doctor at a top Univ.hospital told a med Student that the cause of your vomitting is GI obstruction.Since this was Saturday--he said-come back on Monday. Fortunately a relative who is a top GI specialist decided to do GI procedure on Saturday in his hospital-but before doing that--he decided to do a battery of tests--which revealed--the patient had MONO--that had affected kidney/liver function--the health was getting worse.So 3 more specialists were called in- it took them 6 days--to restore patient to Normal."WAITING 2 days" could have been SERIOUS.
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by mdherder March 20, 2007 4:00 PM EDT
It's interesting to read the complaints about the horrible care received by leidhold and others. Why do I get the feeling these posts come from people who pay nothing for health care? Taking care of the uninsured is part of the mission in teaching hospitals, but this population takes no responsibility as patients. They ignore you when you tell them they need to take their medication which they get for free, and then blame you when they don't improve. They skip appointments and blatantly use the ER for non-life threatening care. A little individual responsibility by the patient is required for a doctor to be successful. In response to the person who says we're all about money...we legally have to pay interpreters to come in if the pt. doesn't understand English. With ever shrinking reimbursements for the underserved pts., we end up $20 in the hole for each visit, & then get stuck paying for the no-show pts. With all the paperwork CMS requires, we can spend 30 min. doing paperwork each office visit. Because of frivolous lawsuits, malpractice insurance can cost $500,000-$1 million a year out of that big pool of money we allegedly make. There are bad doctors, but plenty of irresponsible patients. And here%u2019s some bad news. Over half of physicians, when asked if they would recommend their children practice medicine, said no. It%u2019s predicted there will be a shortage of physicians by 2020. Can%u2019t wait to hear the complaints when you have to wait months to get into a doctor.
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by leidhold March 19, 2007 5:11 PM EDT
most dr's are not good. a tough spot. yeah, you have as many dr's mess up on you as i have, you will not think that. groopamn states that he basically let a woman die because he thought she was irritating. you think that is a good dr? dr's are not better than a robber. they rob us and hurt us. the only difference---a dr goes to school in a blgd., the robber goes to the school on the streets...
i am not laughing. dr's have wrecked my life!!!
my sons life and my husbands, too! i have no sympathy and/or empathy for groopan or any other dr. they all want MONEY!!! MORE $$$$$.
they should first and foremost do THEIR JOB.
btw, good poeple, as you say, don't make good dr's. a robber can be a good person, but hardup for food or money. our society needs to change the way medical care is delivered, POORLY!!!!
leidhold
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by anopinion1 March 19, 2007 2:46 PM EDT
I guess my point was...

If the Doc really dosent know how to diagnose things very well they tend to order many exams and hope someone else can tell them what is wrong with the patient.
and if they are just in it for money they will prob send you all over the place for unessary exams.

overall tho most doc's are good people who just try their best. but everyone wants things to be perfect and it puts them in a rough spot.
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by anopinion1 March 19, 2007 2:35 PM EDT
Before i started working in the medical field i pretty much just thought a doctor was a doctor.

After seeing many things first hand, you start to question things much more. I know a few doctors that should'nt be operating on people. Along with others that are just plain bad family docs. Dont go anywhere unless you know things about the doctor.
Question things.
One thing that is hard tho as a doctor is being over cautious or under cautious. I work in radiology and we have some doc's that order exams on basically every patient they see(for some reason these seem to be the female doc's, probably just chance but still) and some that rarely order exams. I am not positive the actuall statistic but something like 75% of chest and abd-pelvis CT exams are negative.
you try to find a mix of diagnosing things on your own and ordering radiologic exams. (PS one of the largest money making things in a hospital is radiology)
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by anopinion1 March 19, 2007 1:45 PM EDT
apple2pie

Its common sence you dont need numbers.
and pretty much 95% of statistics are completely worthless anyway.
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by leidhold March 19, 2007 2:18 AM EDT
hamiltongrad talks about a true clinical md struggling. lmao...
how about the true patient who gets meds thrown in their face wihtout getting any side effect knowledge from the so-called educated dr's. the dr's who supposedly go to school for so many years and then they complain that they have racked up $$$ for expenses. ha...
give it a break.
dr's are no different than a garbage man who owns his own business or a convinience store owner. all in BUSINESS making MONEY for THEMSELVES.
at least these guys at 7/11 and the garbage man don't mess with or kill people on a daily basis because of prejudice and ignorance. oh, pompousness, too!!!
dr's need to realize that they are there for the patient, not their dang bank account!!!
DO YOUR JOB, DR'S!!! STOP JUDGING. sooner or later, patients are going to stick it to you bad dr's.... STOP THINKING ABOUT YOUR BANK ACCOUNT AND START THINKING ABOUT SAVINF LIVES!!!
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by hypnotoad72 March 18, 2007 8:32 PM EDT
mennowoman -
I'm glad they found it was a thyroid problem. Any doctor worth their cred will do a sufficient battery of tests to rule out physical malaise rather than summarily saying "Do this, now pay me $400 and go on your merry way."

On a tangential facet, I once had a counselor who said the same thing (have ***). It's funny. Especially in "liberal" sects (I don't know of any right-wing-leaning counselors); apparently it's "helpful" to suggest something but then not even offer follow-up advice, tips, or assistance as to go about getting it. In short, they have no clue and prefer to throw out anything that makes them feel better. Junk doctoring. Junk advice. Junk people who get paid too much for blowing people off. (uh, not like that... sending them on their way with junk advice.)

Doctors are amusing and, ultimately, people won't care. It's as simple as that. :) The difference is, people should. We'd be better off as communities and as a country for it. And a world too.
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by hypnotoad72 March 18, 2007 8:26 PM EDT
Having seen a lot of doctors over the years, many of them read a book and pretend to think that's the answer... no, it isn't.

I agree with the folks it's about rushing people through and/or greed. And THAT is where many malpractice originate - rubbish doctors. Maybe reform has to take place as much on the supply side as well as it has to on the 'tort' side. Anybody who wants to protect quacks is against protecting the quality of human life.

In short, EVERYBODY has responsibility and that includes voluntary diseases (STDs, smoking that causes cancer, et al), I regret to say. I have sympathy for those who get it, but maybe if somebody put their foot down, people would respect it, not get it, and be able TO live. It seems I have learned something in this lifetime after all... and if I die trying to get back into shape (lack of exercise, not eating junk food), y'all can heckle my demise too. At least I'm trying to do right these days.
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by mennowoman March 18, 2007 6:18 PM EDT
When I was experiencing depression, my doctor looked at my age and marital status and told me that if I had *** regularly, my depression would go away. He recommended that I find a lover. Seriously. Turned out I have a thyroid deficiency, and that was causing my depression.
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