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Lions Roar : September 2007
SHAMBHALA SUN SEPTEMBER 2007 81 Physician, Know Thyself HOW DOCTORS THINK By Jerome Groopman Houghton Mifflin, 2007; 320 pp.; $26 (cloth) REVIEWED BY MICHAEL KRASNER, M.D. REVIEWS THE ESSENCE OF MEDICINE is the intimate, authentic, and mysterious meeting of two human beings, physician and patient, with the intention to relieve suffering. Both bring their entire selves, with all their levels of transparency or opaqueness, to this encounter. The ability of the physician to listen deeply to the patient and, as a result, respond with insight and empathy to the patient’s dilemma, is one of the core elements in the Hippo- cratic relationship. But this vital ability is threatened by many forces at work in the contemporary health care system. Pres- sures related to the delivery of services, safety, financing, and unrealistic expectations about what modern medicine can provide, coupled with the demand for more compassionate and personalized health care, are leading to unprecedented levels of burnout and demoralization among practitioners and endangering the quality of care. Indeed, many physicians are leaving this esteemed and time-honored profession. The suffering dimension in health care sits at the center of medicine and is experienced on both sides of the physician- patient relationship. This dimension has not been widely addressed within medical education, nor is it part of the ongoing process of reflection and continuing education in most busy clini- cians’ lives. Once they are out of training, clinicians aren’t encour- aged to focus on the nature of their relationship with their patients or on their relationship with themselves. Investigation into the nature of one’s own mind is foreign, maybe even fright- ening, to many of today’s physicians. As Annie Lamott writes: “My mind is like a bad neighborhood. I try not to go there alone.” If this is true for the practicing physician, help is on the way, from the very person he or she is trying to help—namely, the patient. Dr. Jerome Groopman, in his new book, How Doctors Think, provides physicians and patients with a road map for exploring the nature of the health practitioner’s mind. He demonstrates ways in which the medical relationship, when based on trust and mutual respect, can be truly two direc- tional, a bond that returns each partner back to his or her true self. As he writes in the conclusion of the book: I realized that I can have another vital partner who helps improve my thinking, a partner who may, with a few perti- nent and focused questions, protect me from a cascade of cognitive pitfalls that cause misguided care. That partner is present in the moment when flesh-and-blood decision- making occurs. That partner is my patient or her family member or friend who seeks to know what is in my mind, how I am thinking. And by opening my mind, I can more clearly recognize its reach and its limits, its understanding of my patient’s physical problems and emotional needs. There is no better way to care for those who need my caring. Groopman leads the reader through a series of clinical ex- ILLUSTRATIONBYALANGORDON MICHAEL KRASNER is a specialist in internal medicine practicing primary care in Rochester, New York. He teaches Mindfulness-Based Stress Reduction and is currently directing a project that will train seventy-five primary care physicians in mindfulness practice, narrative medicine, and appreciative inquiry. SEPT 72-99.indd 81 SEPT 72-99.indd 81 6/25/07 5:16:15 PM 6/25/07 5:16:15 PM