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Second Opinions—Stories of Intuition and Choice in the Changing World of Medicine

BMJ 2000; 320 doi: (Published 10 June 2000) Cite this as: BMJ 2000;320:1610
  1. David Woods, president
  1. Healthcare Media International, Philadelphia, USA

    Jerome Groopman

    Viking, £24.95, pp 243

    ISBN 0 670 88801 X

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    Coming on the heels of a recent Institute of Medicine report stating that medical error is the eighth leading cause of death in the United States—with a higher mortality than for breast cancer, AIDS, and automobile accidents, and accounting for as many as 98 000 fatalities a year—Dr Groopman's book couldn't be more timely.

    The author, a distinguished Harvard oncologist and haematologist, describes eight separate incidents of misdiagnosis, medical hubris, and egregious error—two of which affected him personally. To alleviate severe pain from a nerve pinched by a bulging lumbar disc, he enlisted the help of an overenthusiastic surgeon instead of opting for bed rest, anti-inflammatory drugs, and tincture of time; he has never fully recovered from the surgery. Later, his firstborn son developed an internal obstruction at 10 months of age and almost died because of physician delay and misjudgment.

    Groopman goes on to describe the case of a woman with leukaemia wrongly diagnosed as having asthma, a patient with melanoma who became the object of professional infighting about the availability and advisability of different forms of interferon treatment, and a young physicist told that he had less than six months to live unless he had a bone marrow transplant and the ensuing tussle between specialists about the usefulness of that approach. In fact, there are several examples here of physicians jockeying for who's right and who's most qualified—turf battles—and Groopman, inevitably involved in most of the skirmishes, is not above a bit of preening when, as is almost always the case, his view is the correct one.

    None the less, much of what might be learnt here has to do with abandoning pretensions to omniscience. As Groopman puts it: “knowledge in medicine is imperfect. No diagnostic test is flawless. No drug is without side effects, expected or idiosyncratic. No prognosis is fully predictable.” Moreover, he believes that most litigation grows, not out of honest errors or even frank malpractice, but from unresolved anger and poor communication. “Physicians are not used to admitting when they are wrong,” he says, “and plainly stating to the patient and family that an error was made, a lab test overlooked, a finding missed on a physical exam, or an incorrect drug prescribed.”

    In all of this, the author's message is salutary: evaluating medical advice is the greatest challenge for every patient. Armed with knowledge, steadied by family and friends, and calling on intuition, we can gain clarity and insight in order to make the best possible decisions.

    But in giving his message, Groopman is also dilatory and serves up a good deal of euphuistic fluff with his thesis. He indulges in narrative excesses such as “the setting sun igniting a blaze of crimson,” “the embracing sun held the city in a pleasant grasp,” and “winter's icy tongue.” The protagonists' stomachs tighten and pulses quicken, cold pains grip their hearts, brows fall, and eyes become heavy. The concocted dialogue is stilted, and one British doctor, for example, is made to include “bloody” or “old boy” in every utterance. And the several gratuitous swipes at managed care, which has arguably brought a greater degree of rigour into medical practice, seem self serving and out of place.

    In fact, although Groopman's message is an important one, it probably could have been confined to a full length magazine article in, say, the New Yorker, for which he is a staff writer in medicine and biology.

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