Throughout those four years of medical school, I was an intense, driven student, gripped by the belief that I had to learn every fact and detail so that I might one day take responsibility for a patient’s life.
At each step we were closely supervised, our hands firmly held by our mentors, the attending physicians. Then we were instructed in how to examine people: listening for normal and abnormal heart sounds palpating the liver and spleen checking pulses in the neck, arms, and legs observing the contour of the nerve and splay of the vessels in the retina. We were taught how to organize a patient’s history: his chief complaint, associated symptoms, past medical history, relevant social data, past and current therapies. The following two years, we learned at the bedside. My medical school classmates and I had spent the first two years in lecture halls and in laboratories, learning anatomy, physiology, pharmacology, and pathology from textbooks and manuals, using microscopes and petri dishes to perform experiments. This was the long-awaited moment, my first day of internship - the end of play-acting as a doctor, the start of being a real one. Despite the heat, I walked briskly along Cambridge Street to the entrance of the Massachusetts General Hospital. On a sweltering morning in June 1976, I put on a starched white coat, placed a stethoscope in my black bag, and checked for the third time in the mirror that my tie was correctly knotted. In this excerpt, Groopman, as a young intern on his first night shift, confronts a life-or-death situation and learns the limits of his hard-won medical knowledge. He studies the snap decisions made by pressured physicians and cautions doctors and patients about the inevitable subjectivity of doctors’ thinking. With precision and empathy, Groopman examines the ways in which the process of medical diagnosis is almost necessarily flawed. Groopman’s latest New York Times bestseller, How Doctors Think, is an elegant overview, drawing on interviews with top doctors across America as well as on his hospital experiences. He also is a staff writer at The New Yorker and the author of the bestselling The Anatomy of Hope, which was optioned by HBO earlier this year. Jerome Groopman ’72, ’76 P&S, is the chief of experimental medicine at Beth Israel Deaconess Medical Center in Boston and holds the Dina and Raphael Recanati Chair of Medicine at Harvard Medical School. Reprinted by permission of Houghton Mifflin Company. How Doctors Think by Jerome Groopman, M.D.
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