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How Doctors Think (Houghton Mifflin Company, $26) takes a gander at the myriad pressures and shortcuts physicians take to handle the mounting caseloads, dwindling time and shrinking insurance reimbursements that’s transforming medical care.

The Introduction outlines the book and underscores the importance of communication through the story of Anne Dodge. The 30-something Massachusetts native spent 15 years taking antidepressants and being treated by doctors who believed she was anorexic-bulimic. Turns out she was allergic to gluten (scary considering how common that type of thing is getting to be). It took a doctor willing to listen to her and not be biased against the eating disorder to figure things out.

The big theme of the book gets pointed out as well, that being physicians’ reliance on patterns of behavior to quickly diagnose and deal with patients. While such approaches seem to work for the most part, they can lead to erroneous and disastrous conclusions.

Chapter 1 recounts the first intern days of author Jerome Groopman, a physician at Harvard Medical School who is also a writer for the New Yorker. It also looks at how the emotions of doctors can cloud and influence their medical decisions.

Lot of good stuff in these introductory chapters.

The main issue for the book are "heuristics," or shortcuts for making decisions. Groopman describes them in Chapter 1: "[H]euristics flourish when a physician assesses unfamiliar patients, or when he must work quickly, or when his technological resources are limited. Shortcuts are the doctor's response to the uncertainty and demands of the situation. They are the essential working tools of clinical medicine, where a doctor must combine thought and action ... the core of flesh-and-blood decision-making. ... The problem is that medical schools do not teach shortcuts. In fact, you are discouraged from using them."

What I'm liking about the book is its frankness. Groopman isn't knocking you over the head with a bunch of fancy words and melodrama, but he isn't dishing out a lot of dry clinical reports either. He provides a pretty concise, clear picture of things, like here:

She had been expecting him to concentrate on her abdomen, to poke and prod her liver and spleen, to have her take deep breaths, and to look for any areas of tenderness. Instead, he looked carefully at her skin and then at her palms. Falchuk intently inspected the creases in her hands, as though he were a foretuneteller reading her lifelines and future. Anne felt a bit perplexed but didn't ask him why he was doing this. Nor did she question why he spent such a long while looking in her mouth with a flashlight, inspecting not only her tongue and palate but her gums and the glistenin tissue behind her lips as well. He also spent a long time examining her nails, on both her hands and her feet. ...

He also seemed to fix on the little loose stool that remained in her rectum. She told him she had had an early breakfast, and diarrhea before the care ride to Boston.

Or this from Chapter 1:

I was about to say goodbye when Mr. Morgan shot upright in bed. His eyes widened. His jaw fell slack. His chest began to heave violently.

"What's wrong, Mr. Morgan?"

He shook his head, unable to speak, desperately taking in breaths.

I tried to think but couldn't. The encyclopedia had vanished. My palms became moist, my throat dry. I couldn't move. My feet felt as if they were fixed to the floor.

Groopman is great at details and giving telling insights into how physicians work. Things can get a little yucky but never for the sake of shock value, just to show how thorough and involved medical work is when people escape their ER picture of things.

For patients (i.e., potentially all of us), these first couple of chapters provide ample reason to educate ourselves about our health and maladies. Groopman explains "Every doctor makes mistakes in diagnosis and treatment. But the frequency of those mistakes, and their severity, can be reduced by understanding how a doctor thinks and how he or she can think better. This book was written with that goal in mind. It is primarily intended for laymen ... because doctors desperately need patients and their families and friends to help them think."

Patients need to find ways to connect and trust their physicians so that communication can be honest and comprehensive. Without that, the psycological baggage that docs bring to the table may interfere with better care. Too often, though, patients don't aim for that professionalism.

Despite research showing that most patients pick up on the physician's negativity, few of them understand its effect on their medical care and rarely change doctors because of it. Rather, they blame themselves for complaining and taxing the doctor's patience. Instead, patients should politely but freely broach the issue with their doctor ... But when I asked other physicians what they would do if they, as patients, perceived a negative attitude from their doctor, each one flatly said he or she would find another doctor.

The other thing I enjoyed was having my own reporting be put into perspective. I write so much about the various issues in the medical community that the big picture can get obscured. Some insights from the tome helped. Stuff like patient satisfaction surveys mean a great deal to United Regional Health Care System, but they don't also seem like compelling news. Then you read something like this

How a doctor thinks can first be discerned by how he speaks and how he listens. In addition to words spoken and heard, there is nonverbal communication, his attention to the body language of his patients as well as his own body languange -- his expressions, his posture, his gestures.

But beyond me as a reporter and us as potential patients, the book at times really sounds directed to practicing doctors. Groopman stresses the need for physicians to ask open-ended questions that can let patients best explain their conditions and to be aware of the compatibility between patient and doctor. The sobering part is how that doesn't happen.

Most errors are mistakes in thinking. And part of what causes these cognitive errors is our inner feelings, feelings we do not readily admit to and often don't even recognize.