Material Summaries:

Hippocrates: The Physician summary

Hippocrates is discussing the preferred physical appearance of a physician. He must present himself as well-taken-care of. He must be fair, proper, and self-controlled, and he can’t be harsh or demeaning, or he will not establish rapport with the patient.

Hippocrates: The Oath summary

The oath is a statement of a physician that he will “do no harm” and always act in the best interest of the patient. A doctor must act dignified and respectful of all patients and must never speak of a patient’s confidential information to another. Interestingly, the oath mentions today’s controversial topics like abortion and physician-assisted suicide as completely prohibited.

Groopman: How Doctors Think Introduction summary

Throughout the introduction, Groopman tells the story of Anna Dodge, a 31-year-old woman who had seen doctor after doctor for years because they couldn’t figure out what was wrong with her. She had been diagnosed with anorexia and bulimia, and later irritable bowel syndrome, but even after increasing her daily calorie intake, she was getting worse. Finally, a new doctor named Dr. Falchuk came in and sat down with her, listening gently to her description of her condition in her words, and he diagnosed her with celiac disease.

Groopman believes the doctor-patient relationship to be created through trust. That trust is founded upon language, mannerisms, and actions. Groopman praised Dr. Falchuk for listening to Anna and letting her explain her symptoms herself with no judgment or wrongly constructed questions.

Groopman criticizes medical school teachings for making students learn the clinical decision tree, a closed, limited way of diagnosing patients’ conditions. He believes that doctors must learn to think outside the box more.

Discussion Questions:

• How much merit does the clinical decision tree have? How helpful is it in diagnosing patient conditions?
• Groopman’s book was published in 2007. Do you think there has been a change in the way doctors have been taught to interact with patients since then?
• Given the controversial medical topics discussed in today’s age, should the Hippocratic Oath be changed, or even done away with?
• In what ways could medical schools teach their students to think outside the box more?
• How much weight does physical appearance have in a patient’s first impression compared to mannerisms?
• What should be the most important step in establishing a trusting relationship between the doctor and the patient?

General Discussion in Response to Questions:

• How much merit does the clinical decision tree have? How helpful is it in diagnosing patient conditions?
  • Should be expounded upon
  • Discussion of topics in this class is binary, similar to the algorithm of the decision tree
  • Can become obsolete when effects on the patient aren’t necessarily biological
  • Helpful in some ways
    • Base understanding of diagnosing patients
    • Good building block to learn off of
    • Provide established method of structure to narrow down diseases
  • Only relying on the decision tree can miss things
    • Can be challenged by preconceptions and tunnel vision
  • Start with decision tree, then go from there
    • Definitely listen to the patient’s descriptions and experience
  • Decision tree must be continually reassessed throughout the patient questioning and treatment process
    • New information can render previous assumptions invalid
  • Decision tree can lead to confirmation bias
  • Decision tree helps administration, insurance cleanly categorize cases
  • Helps people who fit within the “normal” mold of a disease
  • Decision tree treats the condition rather than the patient
    • Makes the patient into a puzzle
    • Similar to a calculator with functions – inputs affect outputs
  • Should be expanded and changed to fit what the patient is saying
• Groopman’s book was published in 2007. Do you think there has been a change in the way doctors have been taught to interact with patients since then?
  • Med school is a classroom setting
    • Loses humanity
  • Primary care physician response has been pretty positive
    • Listen to patients
  • Specialists take the decision tree more into account
    • Natural, given that they are specialists and don’t know the patient as well as primary care
  • Bedside manner can’t always be taught
    • Experience can play a large factor in bedside manner
  • Today, people value quick, easy service instead of quality face-to-face that might take longer
    • Telehealth has exacerbated it
  • Physicians must be able to accept when they’re wrong and question their biases and judgment
    • Can be affected by stereotypes, implicit bias
  • Doctors need to trust the patient more
    • Cynicism is becoming more prevalent
    • Should be skeptic, not distrustful
• Given the controversial medical topics discussed in today’s age, should the Hippocratic Oath be changed, or even done away with?
  • Most medical students don’t actually say the original Oath
    • Have changed it to match today’s social values
    • Has become a list of things to do or not to do, not necessarily the original
  • Should be changed to fit the times
  • There are values in the Hippocratic Oath that are valuable, but not because they’re in the Hippocratic Oath
  • Medical schools should go back to lower tuition
    • Stipulated in the Hippocratic Oath
    • High tuition counter-incentivizes students so that they avoid medical school or accept programs of less prestige and learning
• In what ways could medical schools teach their students to think outside the box more?
  • Did not get to
• How much weight does physical appearance have in a patient’s first impression compared to mannerisms?
  • White Coat Syndrome
    • Patients’ blood pressure increases when they see people wear white coats

• • • • Authority figure makes them stressed out

• • Some people value white coats and suits more
    • Looks more professional
  • Every patient population is different and views doctors differently
    • Physical appearance matters for what type of patient they’re seeing
    • Know the audience
  • How you act is also important
    • Okay to have a personality and laugh, but always remain professional
    • Always take patients seriously
  • Must be conscious of the agenda people have
    • Emotion shouldn’t be ignored
• What should be the most important step in establishing a trusting relationship between the doctor and the patient?
  • Did not get to

Discussion Response:

What I took away from this discussion is that America as a whole is moving towards a quicker, more efficient society at the expense of personal relationships. This is a big problem; the core of medicine is to definitively help someone, and that cannot be completely accomplished without forming interpersonal connections with the patient. However, if bedside manner is falling out of curriculums in undergraduate and medical school, the only way to develop it is through years of experience. As the name suggests, it takes a long time to build that up, and a doctor could see countless patients before a satisfactory, successful bedside manner is developed.

That is why classes like IDMD 101 are so beneficial; not only does it encourage future physicians to think for themselves and create their own opinions, but it also teaches the value of viewing the patient as a person and not just an amalgamation of statistics. Medicine is neither linear nor clear-cut, and the efficiency that the medical field values tries to circumvent that by ignoring bedside manner and embracing concepts like the decision tree.

While such concepts are useful in many situations, there should never be one concept or process that is the end-all-be-all of a patient’s treatment plan. Just as a patient should never be construed as a simple statistic, or another tick on a list of “patients helped today,” physicians should remember that there is never a perfect way to examine and diagnose a patient. It is imperative that physicians learn to adapt to and account for outlying situations like Anna Dodge’s, because looking at a new problem from a conventional stance might not reveal everything that is happening with the patient, and therefore the physician can’t make the most informed estimates on the patient’s diagnosis and/or treatment.