Sunday, January 6, 2008

How Doctors Think

After a few weeks in the Public Library Network queue, Jerome Groopman’s recently published book, How Doctors Think, finally became available, so I promptly picked it up and checked it out. It lives up to its publicity, though the brief reviews and interviews are (unsurprisingly) in some ways misleading. Yes, Dr. Groopman does tell us about doctors usually make snap judgments and how they make mistakes in their thinking. That much is true...and valuable. But focusing on this idea greatly oversimplifies a more complex book. The title suggests a lot more than snap judgments and mistakes. It doesn’t say “How Doctors Think Incorrectly,” but — more simply and more comprehensively — “How Doctors Think.” And that’s what we learn.

Of course it’s more sensational to focus on medical mistakes. The doctor who reaches a judgment in ten seconds rather than ten minutes can be alarming — and even ten minutes seems far too short. What especially interests me is that the two most common mistakes that Groopman discusses are the same as any math students’ two most common mistakes: they want a really quick answer rather than think about a problem in depth, and they want an algorithm they can follow rather than think about each problem individually. Surely it’s no coincidence that doctors and math students fall into the same trap. Groopman tells plenty of true anecdotes about medical errors of both of these types. Like any good story-teller, he writes about concrete examples, involving himself wherever possible, rather than using impersonal, “scientific,” third-person examples. These anecdotes are successful in bringing Groopman’s ideas to life without overwhelming the reader with too many examples.

Doctors are understandably reluctant to criticize each other. Groopman cites plenty of instances of poor judgment, though never by name, and plenty more instances of excellent judgment and devoted care, naming names in those cases. As an oncologist, Groopman is particularly moving in his long exposition of cancer cases in friends, acquaintances, and strangers, where we learn of the many alternatives that physicians have to consider and how they think about those alternatives.

We all need medical care, and we all want to trust our doctors. But we need to be our own best advocates. In some ways this highly readable book will scare you, but in other ways it will give you a glimpse into the mind of the doctor and will help you advocate for yourself.

Dangerous Admissions

Almost any reader would enjoy Jane O’Connor’s satire, Dangerous Admissions, but it resonates especially well for anyone connected with an elite high school, public or private. The setting is the fictional but completely plausible Chapel School, an upper-class K–12 independent school located on the Upper West Side of Manhattan at 349 West 103rd Street, with a four-acre campus extending to Riverside Drive. Google Street View spoils the illusion; I should never have checked.

Freed from its Episcopal roots, the Chapel School has a student body that is now self-consciously diverse, being 50% Jewish and 25% “minority students” on scholarship. The remaining 25% are mostly wealthy WASPs. Everyone wants to go to the very best colleges, and there is tremendous pressure to get into Harvard, Yale, or Stanford. The premise of the story is simple: the head of the Guidance Department is found murdered, and the mother of one student figures out whodunit in the classic tradition of the amateur detective. O’Connor writes in a humorous but never silly tone, making the book fun to read. Many of the characters are teenagers, so of course there’s some of the required sex and drugs, but not to the point of unbelievability. And even the slightly sensationalistic aspect of the material is relevant to the characters and the plot; no reader will think it’s gratuitous. It’s not Weston High School (the wealthies high school in MA), but that’s only because the Manhattan setting is integral to the story. Otherwise, even though Dangerous Admissions takes place in a private school, it might as well be Weston or any other wealthy public school.

The fact that the amateur detective is a copy editor makes the book even more delicious in my eyes. Fortunately Dangerous Admissions itself has been meticulously copy-edited, unusually so among current paperbacks; it would be too ironic if it had not been. Rannie Bookman, the appropriately named protagonist, keeps resisting the impulse to correct misplaced modifiers and the like. I appreciate that (the impulse, if not the resistance).

Needless to say, I highly recommend this novel. Go read it!

Yiddish Policeman's Union

Just finished reading The Yiddish Policeman’s Union, by Michael Chabon. This hybrid novel fits squarely in the hardboiled-detective genre — except that it also fits into the alternative-history genre. The premise is that the state of Israel failed almost immediately in 1948 under a defeat by the Arabs, so European Jews fled to the newly established Jewish homeland in Sitka, Alaska. After half a century, this fictional homeland (where Yiddish is spoken, not Hebrew) has seen three generations of Jewish inhabitants, one of whom (Meyer Landsman) is the Yiddish policeman of the title. Although Chabon’s premise may sound implausible, in fact a Jewish homeland in Sitka was actually proposed by Interior Secretary Harold Ickes, so it could have happened.

Anyway, I’ll stay away from giving any details, lest I inadvertently include any spoilers. Let’s just say that the beginning is a little slow, especially as the reader has the task of figuring out what’s going on in this world. That task, of course, is common in science fiction, but science fiction rarely has the attention to character that The Yiddish Policeman’s Union has. So you have to learn about the fictional world, get to know the characters, and understand the plot, which is initially confusing and contains a surprising amount about chess, various Jewish chassidic sects, not to mention a bit about Esperanto and other apparent irrelevancies. But it’s well worth persevering, since the initial difficulties start to fade away to reveal a fascinating integration of all three — the alternative history, the characters, and the story line. Do read it as it's a lot of fun!