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In his newest book, Dr. Jerome Groopman offers
sage medical advice to patients facing the maze
of medical care in the 21st century.
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DIANE COLE
Special to the Jewish News
IV
ho among us hasn't
wished on a particularly
callous or arrogant doc-
tor a bitter taste of his
own uncaring medicine? Instead of feel-
ing guiltily vindictive, breathe a healthy
sigh of relief. There really are doctors
who, as a result of their own bouts with
serious illness, feel exactly the same way.
Listen, for instance, to Jerome
Groopman, M.D., for whom a
patient/doctor role reversal made an
immeasurable impact on the way he
practices medicine.
"My first experience as a patient
proved as instructive as all my classes
in medical school," he candidly con-
fesses at the start of Second Opinions:
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Stories of Intuition and Choice in the
Changing World of Medicine (Viking:
$24.95). The book is an insightful
examination of the shifting relations
between doctors and patients.
Twenty years ago, he relates, compli-
cations from dispiritingly unsuccessful
back surgery endowed him with a lega-
cy of chronic pain that will never let
him forget — neither as he examines
patients nor goes on hospital rounds
— the sense of helplessness and some-
times hopelessness felt by anyone who
has ever lain immobile and unheard.
For Groopman, a well-known
oncologist, AIDS
researcher and staff
writer for The New
Yorker, never far from
the surface, either, are
other searing memo-
ries of his personal
education in empathy.
First came the
agony of watching
his father die of a
massive heart
attack;
intensifying the grief was the terrible
knowledge that better care might have
saved him. But the community hospi-
tal to which the ambulance driver
unthinkingly rushed the patient pro-
vided no cardiologist, no intensive care
unit, only the most rudimentary care.
As first-time parents, Groopman
and his wife, Harvard-trained physi-
cians both, experienced the same anxi-
ety and powerlessness as any nonmed-
ical expert as they raced their critically
ill nine-month-old son to a jam-
packed emergency room in the after-
math of a pediatrician's potentially
fatal misdiagnosis of their child's life-
threatening condition.
And that was only the beginning.
Just like everyone else, their medical
credentials notwithstanding, they had
to battle against the lackadaisical
response of a harried, first-year resi-
dent who seemed more intent on sign-
ing off duty than performing his med-
ical duty. Only their persistent, active
prodding resulted in the immediate
surgery that saved their son's life.
Each encounter left enduring scars,
both physical and psychological. But
viewing medicine from all different
sides of the hospital bed — as patient,
concerned family member and doctor
— taught Groopman crucial lessons in
compassion and care.
In the deeply felt Second Opinions, as
in his first book, The Measure of Our
Days: A Spiritual Exploration of
Illness (Penguin Book; $13.95),
Groopman presents riveting
case histories of patients suf-
fering from a variety of can-
cers and other diseases.
They serve to dramatize
how terribly awry modern
medicine can go when cost-
cutting, cookie-cutter
approaches depersonalize
rather than heal.
Dr. Jerome
Groopman: "There
should be no ego
involved in
getting the
best care."
In one case, that cost-control "factory
mentality" of managed care, as
Groopman calls it, cost a woman's life.
Because they fell outside the "clinical
algorithm" at her HMO, her doctor
never bothered to administer the chest
X-ray and blood tests that would have
shown the patient's "routine" symptoms
of asthma were in fact caused by a fast-
advancing form of leukemia.
But private practitioners can cut
corners, too, when money is on their
mind, Groopman warns. When a
wealthy patrician seeks a second opin-
ion from Groopman, the doctors at
the patient's community hospital try
to retain him, despite their lack of
expertise and inability to provide state-
of-the-art care for his hairy cell
leukemia — because they fear losing
his large charitable contributions.
Of course, we all want the best care. At
the same time, the powerful new tech-
nologies research has given us should not
be administered by rote, Groopman cau-
tions. Too often, the desire to act can
overcome the knowledge that a particular
therapy is unlikely to work.
Sometimes, the best course of action
proves the least sexy. As one of
Groopman's mentors put it: "Don't
just do something — stand there!"
In addition to his understanding
that every patient's needs are distinct
and individual, Groopman's greatest
gift is his ability to cut through con-
fusing medical mumbo-jumbo. Both
doctors and patients can learn much
from his basic points on the changing
nature of medicine today:
• Modern medicine often relies as much
on intuition — and luck — as technol-
ogy. We want to think of medicine as
a science, with comforting data to
back our decisions. But unpredictable
outcomes, both good and bad, have
taught Groopman that, "even with all
the clinical information, medicine
was not physics. The inherent vari-
ability of human biology meant judg-
ment could not be reduced to mathe-
matical calculation."
As an illustration of the subjectivity
of medicine, Groopman and a highly
regarded colleague view the very same
data, but sharply disagree on both the
diagnosis and the course of treatment.
Both the doctors and the patient must
learn to make therapy decisions based
as much on clinical experience as
trusting their gut."
In another case, a patient's failure to be