How Doctors Think Can Affect Diagnoses

Dr. Jerome Groopman Says Physicans Bring Their Personal Biases To The Exam Room

(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.

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Read An Excerpt Of "How Doctors" Think"

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"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.

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Excerpts from Dr. Groopman's interview with CBS Evening News anchor Katie Couric:
How To Be A Better Patient
Doctors' Pet Peeves
Disliking The Sickest Patients
If The Doc Likes You Too Much
Doctors' Emotional Baggage

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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.

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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.

[ldsims1155]

I am one of those cases. I went to the doctor and had very high cholesterol, I was depressed, and had gain a small amount of weight. Their diagnosis: I was depress due to a divorce, I was eating fatty foods, which I strongly denied, and was not exercising enough. The REAL diagnosis a good year later: I was riddled with Thyroid cancer, stage III, and after two surgeries, and two rounds of radiation...I am still here. Please...doctors really need to listen.

[ecuadoriana]

When my daughter was 6 mos old I noticed a golf ball sized lump in her leg. Being a young single mother I was used to being looked down the nose at by everyone from the grocery clerk to the medical profession. We made several trips to pediatricians & the ER & was told it was an infected lymph node, which they drained & eventually removed (always had to cough up the cash first, though- had no insurance).

By the time she was 2 she had several "infected lymph nodes" drained or removed. Last resort I took her to Boston Children's Hospital. There was a massive panic- she had TB! TB- highly contagious & deadly!! Turns out all the previous times her nodes were drained or removed no one bothered to send them for lab tests! ***!

Thankfully after major surgery & a year of medication she lived to tell. How dangerous- not only to her & me, but to the general public- for all those prior pediatricians to give substandard care because of their personal bias against young single mothers!!!! And this was back before everyone was litigation crazed or else I may have jumped on the mal-practice band wagon!

[bildooreilly]

Most doctors are quacks, it's all about blinding you with brilliance or baffling you with bullshiite... Lets take the Symbol for "modern medicine" for instance the caudacus, and find out their PHILOSOPHY From the book "Alchemy & Mysticism" The Hermetic Museum by Alexander Roob... the book says..

"These are the two snakes fastened around Mercury's staff with which he demonstrates his great power and changes into whichever form he wishes.. When these two are placed together in the vessel of the Dead Tomb, they bite one another cruelly. Through putrefecation they lose their first natural forms to take on a new nobler form.. The reason why I make you draw these two seeds in the form of thei dragon is because their stink is very great and their poison... (Nicolas Flamel, Chymische Werke, Hamburg Edition, 1681)

This is where modern medicine comes from, they poison you to fight poison, they think two negatives = a positive... QUACK QUACK QUACK

[godbless7]

It is unfortunate but true that many doctors rush you in order to meet quotas with their employer or due to their own greed due to lower reimbursement rates.15/20% misdiagnoses is due to "rush" and doctor's thinking based on common answers--not unusual possiblity of some other problem.
We have suffered from misdiagnoses as well as hurried surgery.My advice--CHANGE the doctor who rushes you.
Next advice is to check their education/training.Board Certification tells you that they passed--but they may have missed one out of four questions.In other words,they did not know the answer to one question out of four.
If you do not get better soon(within 2 weeks),try another doctor--DO NOT RISK YOUR LIFE.

[paingirl-2009]

I am a mid 40's female. I have experienced as early as my 30's both female and male doctors not taking issues at hand; they play very fast and loose with the anti-depressants to treat ANY ailment especially in the case of women!; they are very quick to treat the "symptom" (if your lucky) and not the body as a whole. Very quick to blame the patient. They want your money and you out of there.

Bottom line they don't care. Patient beware.

[ampsanne]

Having moved to a different city I went to a doctor who thought she was God. I am a diabetic and all she could preach was her diabetic classes---me going to diabetes classes after having it for 20 years. I also had a hole in my big toe which she said would get better. I asked her about going to a foot doctor and she didn't care for the idea. Well I went to a foot doctor and found out it was an ulcer on my toe. Shortly after that I received a letter from the doctor that she no longer wanted me as a patient. Fortunately my toe heeled and the foot doctor told me I was very lucky that I didn't lose that toe, and lucky that it healed completely as most diabetics don't. I certainly feel the doctor was a quack for sure. I now go to a Diabetic Center and the doctor there said I have both kinds of diabetes and also changed my insulins and credit them with saving my life. I was doing everything right as a diabetic, but the insulins needed to be changed and certainly no diabetic classes would have taught me that.

[bondmd1]

Must be nice to be inside the cloister home- MGH/ BWCH at Harvard to pass judgments on your colleagues.

Why not spend a day in a family physician and internists office. Just try- also, come back at the end of the month when we get the receivables and expenses. May be the university and you can start a charity, shell some cash out.

Day in and day out you hear- medical expenses are on the rise- true . Where did the money go, check out the stocks of Cigna, aetna , wellpoint united health care. See the CEO bonuses. see what GE and xerox are profiting and check out the pharma porfits and the pharmacy profits- check it out

And well- the physician- we are fighting 5- 17 % cut in reimbuirsement.Besides stone walling , lack of medical necessity and prior authorisations etc etc etc ..........Then the DEA and OIG and the state physician boards and lawyers and local media????


And What about Patient responsibility - dO THEY HAVE ANY. dO THE MEDIA AND iNSURANCE COMPANIES HAVE ANY RESPONSIBILITY?

NO ITS THE DOCTOR- FORGET ALL THE GOOD THEY DO FOR A 99213 VISIT PAID 25- 35 $$$


AND YOU PROFESSOR AT HARVARD Groopman YOU SHOULD BE ASHAMED FOR NOT BEING TRUTHFUL AND FACTFUL. MAKE SURE YOU SET UP YOUR KIDS AND GRAND KIDS A GOOD TRUST FUND WITH THE SALE OF YOUR BOOK , WHILE WE DO CHARITY AND DEDICATED WORK AND FLUSH YEASR OF HARD WORK AND EDUCATON DOWN THE TOILET!!!

[leidhold]

i have been hurt more than 3x by doctors in my life. a dentist, a shrink that i went to because of the dentist, and an ob who damaged my baby. all woman doctors with children. i am a woman. all the doctors that i have gone to in nm and tx have been pompous and all-knowing. they think that meds and their practice is the best. they think they know everything, then they mess up, they blame the patient! groopman, you are so right. i have had an internist (a male) tell me that my pain was all in my head and once i figured out in my head what was wrong, i would feel better. well, i have interstitial cystitis, and constant muscle spasms in my bladder/kidneys. all the doctors want to do is put toxic chemicals up my bladder, give me anti-depressants, take my bladder out, implant interstim (not approved for my disease), and tell me that i need to learn how to cope. how do i cope with chronic ic (from anticonvulsants) and a baby who has cp from a bad delivery? the first posting was from another doctor ditzing groopman. who went to medical school? you doctors are SUPPOSED to be educated?? doctors should have to go thru more CME (continuing medical education) per year. doctors need to go back to school to LEARN how to NOT KILL US/MESS UP OUR LIVES. get these doctors back into cme NOW! doctors mess up really bad, then they blame the patients/lawyers. when doctors mess up, they should be held accountable. send then to jail like the regular joe.

[leidhold]

this is an addition to my previous post.
misdiagnosis and no diagnosis is medical malpractice. doctors are no better than anyone else running a BUSINESS! that's what it is in our lifetime---a BUSINESS! doctors are not out to save patients, they are out for their $$$ POCKET, including you groopman. why should a doctor who hurts patients be any different than the guy who steals a loaf of bread and hurts someone in a store robbery? go to jail, get your card, doctors. you all are no different when you mess up someones life compared to a robber or someone who is convicted of manslaughter. it is MALPRACTICE WITH CAPS!!!
leidhold

[leidhold]

bondmd1 asks about repsonsibility? who went to medical school?? you did, donk doctor. go back to school and learn how to write. you have caps and lower case throughout your post. did you go to school, bondmd1? lmao...
you want to pass the responsibility onto everyone except the medical community. blame everyone else except your profession, bondmd1.
DENIAL...
you need a therapist, bondmd1 and every dr like you who denies and hurts patients.
leidhold

[mennowoman]

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.

[hypnotoad72]

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.

[hypnotoad72]

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.

[leidhold]

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!!!

[anopinion1]

apple2pie

Its common sence you dont need numbers.
and pretty much 95% of statistics are completely worthless anyway.

[anopinion1]

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)

[anopinion1]

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.

[leidhold]

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

[mdherder]

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.