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Respected AIDS and cancer specialist Jerome Groopman, M.D., discussed the convergence of illness and spirituality in his first book, The Measure of Our Days. In Second Opinions: Stories of Intuition and Choice in the Changing World of Medicine, he shifts his focus to the ways intuition informs his medical decisions and enhances the quality of his patient relationships (even giving him an edge when examining a patient on referral). In eight chapters that vividly recount cases whose outcomes hinge as much on the doctor's gut feeling and empathy as on his expertise, Groopman eschews the impersonal and know-it-all role of the doctor, describing instead dire cases in which careful consideration of both the emotional and medical issues positively impacted his approach to treatment.
"A clinical compass is built not only from the doctor's medical knowledge but also from joining his intuition with that of his patient," Groopman writes. "This melding of minds occurs when the physician probes not only his patient's body but also his spirit." This uniquely integrated compass is the guide that determines the safest, least traumatic treatment for people who are in advanced stages of illness or whose diagnoses are clinical conundrums. Of the eight stories here, there's Isabella, who was diagnosed with asthma but actually has acute leukemia; Peter, whose sickness is an enigma although he's clearly dying of a vicious lung-tissue disorder; and Alex, who will die from bone marrow failure unless its exact cause is identified. Groopman's narrative nimbly relates all the details of his patients' battles as well as the professional and emotional steps he takes when facing a medical challenge. In most cases, he has been sought out to provide a second opinion of the patient's diagnosis and proposed treatment. More often than not, the original diagnosis was inaccurate and Groopman's meticulous and insightful examinations yield findings that mean the difference between life and death.
Second Opinions is a thoughtful, riveting book and a compelling tribute to the efficacy of medical care when handled responsibly and with empathy. It is also a cautionary collection of stories that reveal oversights inevitable in the health-care industry's rush to maximize efficiency, and as such it teaches an important lesson about the patient's role in ensuring a high quality of care. While Groopman runs the risk of seeming self-congratulatory, he proves himself a trustworthy advocate of patient empowerment and his sincere, articulate portrayal of intuition's subtle force will be inspirational for anyone confronting illness. --Rebecca Wright
From Publishers Weekly
As he so ably demonstrated in The Measure of Our Days, Groopman, a clinician and researcher at the Harvard Medical School, writes expressively and compassionately about illness. In the eight case histories presented here, he beautifully illustrates his strong belief that "a clinical compass is built not only from the doctor's medical knowledge, but also from joining his intuition with that of his patient." A well-respected hematologist told Alex Orkin he had six months to live unless he underwent a bone marrow transplant. In the absence of an appropriate donor, a very dangerous unmatched transplant was scheduled. Orkin then consulted with Groopman, who, after repeating many tests and getting to know his patient, concluded that the diagnosis was unclear and the proposed transplant too risky. Groopman intuitively decided to rely on a dictum learned in medical school: in some cases it is preferable to do nothing. Despite one scary bout of pneumonia, Orkin's marrow production increased and he recovered. Some of the other histories don't end so happily, however. One case involved a misdiagnosis of asthma by a managed care physician; by the time Groopman became involved and correctly diagnosed acute leukemia, it was too late. The author is convinced that the money-saving practices of HMOs are causing a loss of quality medical care. He also movingly describes his own experience, in which his infant son nearly died because the pediatrician, a poor diagnostician, apparently overlooked a serious condition. Fortunately, the medical expertise of Groopman and his wife (also a physician) saved their son's life. This is an excellent book by a thoughtful physician. First serial to the New Yorker; second serial to Good Housekeeping. (Mar.) Copyright 2000 Reed Business Information, Inc.
From Library Journal
Continuing the social commentary on medical themes that he began in The Measure of Our Days, Groopman here focuses on medical decision-making; in eight dramatic case studies, he reveals the importance of honoring intuition in the evaluation and treatment of illness. The cases illustrate how the managed-care system rewards speed at the expense of sustained individual attention. They tell of patients who are ill informed and of physicians who are unwilling or unable to allow for second opinions. Groopman weaves his story together with impassioned humility, but his message seems lost, at times, in the drama. Recommended for larger public libraries.-Andy Wickens, Univ. of Washington Health Sciences Lib., Seattle Copyright 2000 Reed Business Information, Inc.
From Beliefnet
Harvard Medical School professor Jerome Groopman has written a gripping collection of essays that portray American doctors as a cold-hearted bunch, more concerned with rote solutions than with their patients. Groopman indicts the medical profession for paying more attention to the bottom line than to wellness. The case studies in "Second Opinions" are horrifying. Take Groopman's patient who had been diagnosed as asthmatic. Asthma medicine wasn't helping, and she felt sure she suffered from something other than asthma. But her doctors ignored her. When Groopman finally examined her, he realized she had leukemia. Doctors' need more than a friendlier bed-side manner, says Groopman. They need to pay attention to their patients' intuitions--the woman with leukemia knew long before her doctors listened that something far more serious than asthma was wrong. Anyone who has been treated by doctors--but not treated well by them--will find "Second Chances" disturbingly familiar. Even readers who have never experienced shoddy care will be outraged. One can only hope that doctors listen up--to Groopman, and to their patients.
The New York Times Book Review, Howard Markel
In a very real sense Groopman's tales reveal much that is wrong with the modern practice of medicine...
From The New England Journal of Medicine, April 27, 2000
Second Opinions: Stories of Intuition and Choice in the Changing World of Medicine, Jerome Groopman's second collection of clinical stories, illuminates the mysteries and uncertainties of serious illness and the fears it evokes in both patients and doctors. Writing for a wide audience in clear and precise, nontechnical language, Groopman offers these stories to deepen and enlarge the experiences of patients and doctors in a health care system that seems to have lost sight of its mission. More specifically, his angle of vision comes from a whirlpool of conflicting diagnoses and human error, the bureaucracies of clinical trials and managed care, chance, faith, an unyielding attention to detail, and invariably, hope. Each of the book's eight chapters is a clinical story involving a patient with a life-threatening illness. The stories focus on people who face myelofibrosis, acute leukemia, hairy-cell leukemia, breast cancer, and marrow failure of unknown cause. Two chapters are Groopman's personal accounts: "Our Firstborn Son" is the story of his infant son who almost died because of a misdiagnosis, and "Grandpa Max" is the story of Groopman's grandfather, who had Alzheimer's dementia. Threads connect all the stories, weaving back and forth between laboratory precision and puzzling findings, rote clinical formulas and time-consuming exploration, self-confidence and uncertainty, and "attention to minutiae and a mind open to the unexpected." Of all the stories he could have selected from many years of patient care and clinical research, Groopman chose these eight as the "critical moments that have forever shaped my thinking and practice -- not only for my patients but for my family and myself." They include, Groopman tells readers in the prologue, times "when my opinions and actions proved right and when I seriously erred." Groopman is a skilled storyteller. His descriptions of patients facing crises are quietly respectful, often accompanied by an unflinching critical gaze on his own practice of medicine and the difficult role he and others assume in dealing with the uncertainties of illness and recovery. His desire that all people have the means and knowledge to make informed decisions is evident in each chapter, indicated not only by the exchanges between Groopman and his patients but also by the complex information about each disease process that he provides to readers. In each case, including those involving his own family, he convincingly argues that doctoring is a "balance between the sixth sense of intuition and the tedious reiteration of diagnostic lists. You [don't] have to be brilliant to be a competent doctor, but you [do] have to be thorough." Acknowledging that doctors cannot pass through their careers without making mistakes, he nonetheless does not forgive himself for his own. "I believed," he writes, "that forgiving would mean forgetting and make me prone to more unwarranted assumptions." I was reminded of David Hilfiker, another doctor who wrote candidly about a life-altering mistake he had made (Facing Our Mistakes. N Engl J Med 1984;310:118-22) but who suggested the opposite -- that doctors are cut off from healing when they are unable to forgive themselves. Groopman clearly inserts himself as a major character in each of these stories, sharing his patients' crises with the firm belief that every doctor needs "deep knowledge of his patient and his disease and ready access to first-rate technology." This statement and others like it are, of course, what all desperately ill people want to hear, especially from their doctors. I would want someone with Groopman's expertise and connections taking care of me if I were seriously ill. Yet even in my agreement with Groopman's unwavering commitment to the art and science of medicine, I was aware, as I read his book, of the astonishingly elite world he inhabits. He openly acknowledges this fact: "I did occupy a privileged position in the world of modern American medicine.... If I saw one person or ten in the clinic, it made no difference. If I wanted to spend an hour rather than fifteen minutes to examine and talk with a patient, I could. No one imposed `cost effective' clinical algorithms to stay my hand from pursuing a more intensive evaluation." Moreover, most of the patients whose stories Groopman recounts -- not all, to be fair -- were well-educated, assertive, and often economically privileged people: the patriarch of an old New England family with Miss Porter's School and Barnard College traditions, the chief executive officer of an international oil company, a physicist at the Massachusetts Institute of Technology, and a family friend. Even Groopman's personal stories do not escape the privilege of being well connected. Knowing how to find one of the most renowned pediatric surgeons in the United States when your child is sick and having New York's most respected specialist in dementia examine your grandfather are blessings most people cannot even imagine. I say this not to diminish the value of these stories but to point out that other stories of second opinions need to be told. For example, faced with the same illnesses, what do uninsured people do or those who are poorly educated and have no links to medical care? How would these stories be told by skilled and caring doctors in health maintenance organizations who struggle to reconcile the needs of their patients with the demands of corporate medicine? What about the isolated rural practitioner without ready access to "first-rate technology"? Second Opinions is a finely crafted book showing how eight patients and their skilled and determined doctor worked together to make critical medical decisions. It is a book that represents one small segment of a national discussion that is needed to determine what we want our health care system to be, and for whom. Delese Wear, Ph.D.
Copyright © 2000 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
From Booklist
Readers of Groopman's New Yorker articles won't need a second opinion to decide to read his new book consisting of eight well-written, thought-provoking medical histories. These accounts are by no means impersonal, because the patients accounted for include Groopman's first-born son, his grandfather, two close friends, and another physician. So, what underlies the proper physician-patient relationship? "Careful listening is the starting point for careful thinking," Groopman says, and sufficient time is necessary for such listening and careful examination. Groopman is fittingly harsh on HMOs' tendencies to deal with patients quickly and under financial constraints. His eight model patients illustrate their and their families' fear, despair, and physician-induced isolation from decisions and the processes of care. Their problems range from Alzheimer's to obscure diseases, and their treatments include bone marrow transplants and other major procedures. Physicians, in training and in practice, as well as patients and their families stand to learn from Second Opinions. William Beatty
From Book News, Inc.
A physician and staff writer for The New Yorker magazine explores how doctors and patients make critical decisions, offering eight clinical dramas that give insight into social and economic forces at work in the world of medicine, motives of caregivers, and the hope and limits of new treatments. The author teaches medicine at Harvard Medical School and is a leading researcher in cancer and AIDS.Book News, Inc.®, Portland, OR
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