Dr. Dinosaur Analysis: How Doctors Think

Dr. Dinosaur’s post showed up in my Google alerts and it turns out that he evaluates Jerome Gloopman’s book, How Doctors Think. Dr. Dinosaur’s expectations for the book are met with disappointment:

"As I read through the book, though, I realized that the omission of psychiatry and the discussion of the proper role of psychiatric diagnosis in medicine (as opposed to the misdiagnosis with which he opens the book) renders many of his comments irrelevant to the day-to-day practice of medicine in the community. By "community" I specifically refer to the non-Harvard, non-Massachusetts General, non-assorted-other-institutional-names dropped in the name of prestige. Out here in the real world, psychiatrists think just like the rest of us. They care for diseases that are primarily mental in origin. These diseases have criteria for diagnosis, treatment protocols, risk factors and prognoses. Making these diagnoses is often straightforward — and sometimes less so. Treatment succeeds or fails, or stops working, at which point it often helps to change the treatment or re-visit the diagnosis. Sounds a lot like medicine, because it IS medicine."

My favorite anecdote from Dinosaur’s post:

"I have experienced this phenomenon. A patient of mine almost from the day I hung out my shingle kept having great difficulty with depressive symptoms and anger issues. Antidepressants didn’t really help, nor did counseling. About two years ago I attended a seminar on Bipolar Disorder, including the fact that it’s far more prevalent than previously recognized, and that it’s much more than just classic manic-depressive symptoms. One of the talking points was that on average, patients waited seventeen years before being correctly diagnosed. After that, I brought tools from the seminar into my practice. I didn’t go around diagnosing everyone with bipolar, but I did begin recognizing it more than I had. The first time after the seminar I saw the lady I mentioned, I listened to her telling me once more about her symptoms; her anger, her explosiveness. Whoa, I thought. I whipped out the Mood Disorders Questionnaire from the seminar to confirm my impression. Sure enough, now that I had become familiar with a diagnosis with criteria different from what I had learned, I was able to see her in a new light. I treated her with mood stabilizers, and she responded beautifully; very grateful that "something finally worked!" I looked back over her chart. Ironically, it had taken seventeen years to make the diagnosis."

Perhaps the rising percentage of people suffering from bipolar disorder can be attributed to misdiagnoses as opposed to bipolar being the "hip and trendy" mental illness to have. (Although, the latter is true among teenagers.)

3 Comments

  1. Rick said,

    May 3, 2007 at 11:22 am

    Wow, 17 years. That’s almost one full quarter of a human life span.

  2. Djeniba said,

    January 9, 2008 at 11:43 pm

    I have some days were i am crazy and fun to be around, and then other days were i feel like, why am i on this world, and that i want to die. I know that sounds crazy. but its true, i’ve never actually atempted to suicide, but i think about suicide and death a lot. I swear i’m not a physico or anything, but i feel like I need to be cured. Will you please help me?

  3. March 31, 2014 at 1:52 pm

    Let’s talk about it!


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