|A CONVERSATION WITH...|
June 8, 2000
GWEN IFILL: One of the most difficult dilemmas patients face is knowing
when to follow the first advice their doctor gives, and when to push
harder, ask more. In his new book, "Second Opinion: Stories of
Intuition and Choice in the Changing World of Medicine," Dr. Jerome
Groopman shares true stories from his own personal experiences as a
patient and as a physician. A Professor of Medicine at Harvard Medical
School, he is also chief of experimental medicine at Beth Israel- Deaconess
Medical Center, and a staff writer in medicine and biology for the "New
DR. JEROME GROOPMAN, Author, "Second Opinion:" Pleasure to be here.
GWEN IFILL: You talk about intuition and choice, which for me sound like two of the scariest words you can use in talking about medicine.
DR. JEROME GROOPMAN: But they're very important. No one knows your body as well as you do. And it's important for a patient, when he or she is sick, to try to probe and sense what's going on and to offer that to the doctor. It helps the doctor make diagnosis and chart the best therapy.
GWEN IFILL: You talk in your book... you tell a series of stories in your book, which we'll go into in a moment, but all of them boil down to this idea of the unknowable, which for some reason I think a lot of us throw ourselves in doctors' hands and assume that the doctors will be able to just give us a flat answer, but that's so often not the case, is it?
DR. JEROME GROOPMAN: It's not. None of us, as a physician, is perfect. I have my limits, areas of ignorance, times that I make misjudgments. I need the patient to be active and to be speaking to me, to form a real partnership, to do the best I can.
GWEN IFILL: But that's more than misjudgments. It's also a doctor who happens to be tired or who is arrogant or who isn't really listening. You tell a story about the case involving your young son, your son when he was young, and when you took him to an emergency room.
DR. JEROME GROOPMAN: He was nine months old. We were first visiting my wife's parents in Connecticut. We saw an older pediatrician, who dismissed my wife's intuition that our baby was really quite ill. He said it was just a GI Bug. By the time...
GWEN IFILL: Gastrointestinal.
DR. JEROME GROOPMAN: Gastrointestinal virus, basically. He had some diarrhea and didn't look himself. By the time we got to Boston, it was clear he was very, very sick. He was ashen, his legs were flexing to his chest. We rushed him to the emergency room. And there the correct diagnosis was made: He had an intestinal obstruction. But we were met by a very green, inexperienced resident who said that there was no need for urgent surgery and everything could wait till the morning.
GWEN IFILL: But what happened in the end then?
DR. JEROME GROOPMAN: What happened is we had to stop being passive, cowed parents and take action and challenge his judgment. And by good fortune, there was one person we knew at this hospital. We called him in the middle of the night. He brought in a senior surgeon, who rushed our baby to the emergency room and saved his life.
GWEN IFILL: Here's the point: You're a physician, your wife is a physician, and this still almost happened to you. You tell another story in the book of another woman who was diagnosed as having asthma by the doctor, her HMO and then she came... her daughter brought her to see you for a second opinion, and you discovered that wasn't the problem at all.
DR. JEROME GROOPMAN: What this means is that when you sense that you're not being listened to, that you're not being taken seriously, or you don't fully trust the decision that's being made, because the person seems to be dismissing you or seems very inexperienced, you have the right as a patient and a family to demand a second opinion and to see a more senior person.
GWEN IFILL: This woman in this case, who was later diagnosed as having leukemia, she wasn't English- speaking, wasn't her first language; she didn't live in the same community was you; you weren't covered under her HMO. There was a good chance she would've never sought a second opinion with those circumstances. And most people probably feel they're constrained by those kinds of limitations.
DR. JEROME GROOPMAN: Many people are. It's one of the most difficult and upsetting aspects of medical care delivery-- people who are culturally disadvantaged, financially disadvantaged. But even now, within the HMO or managed care networks, you can demand to a patient advocate to get a second opinion. And the HMO's are very much on the retreat now. They're not doing well financially, and if you press hard enough, you can get greater freedom of choice and you can go outside the network.
GWEN IFILL: We hear a lot about medical horror stories and read frequent reports about medical errors. Is this something which is a big widespread problem? Reading your book would make you think so. Or is this something where perhaps we're just overreacting, in the broad sense?
DR. JEROME GROOPMAN: I think it's important. I think there are two types. One are system errors: Poor handwriting, so that the correct dose of a drug is not given, things like that. And those can be fixed more easily. What my book focuses on really has to do with judgment and how to come to the best diagnosis and the best treatment. And that requires a patient and his family being more aggressive and more proactive than all of us usually are.
GWEN IFILL: Did you worry in writing this book and committing these stories to print, that people were going to be even more scared and less likely even to seek medical opinions, or less trusting of your profession?
DR. JEROME GROOPMAN: Well, I think that people may be worried about these issues, and the best way to overcome worry is to gain knowledge. And that knowledge gives all of us power. A woman contacted me shortly after the book came out and had read the exact story you referred to about the HMO. And her son, 11 years old, had fever and cough, and twice she was brushed off. And she marched back to the HMO, demanded that he be seen. He had pneumonia, and he was immediately admitted to the hospital. And I thought, "that's the kind of courage that I hope people can get from this."
GWEN IFILL: So in general, how does a person know when to ask for a second or a third or a fourth opinion?
DR. JEROME GROOPMAN: Well, I think anyone who has a life-threatening illness should get a second opinion. Anyone where the diagnosis is not clear; where the treatment is either very risky or toxic; or where the treatment is experimental, there is no established therapy-- in every case you should get a second opinion.
GWEN IFILL: I had a friend say to me recently, "well, the doctor should know best. The doctor was the one who is trained and knows so much more than I do." It's so easy to be intimidated in those situations.
DR. JEROME GROOPMAN: Well, we were intimated. My wife and I, both of us, intimated, even though we were doctors, because we were trying so hard to be cooperative. But we made what could've been a fatal error. I think it's critical for all of us to know that doctors are human, they have they're limits, they're fallible. I certainly have made mistakes and I confess, I even write about them in the book.
GWEN IFILL: So you're saying it pays to be stubborn in these cases.
DR. JEROME GROOPMAN: It pays to be persistent; it pays to speak up; but most importantly, to develop a partnership with the doctor.
GWEN IFILL: What's interesting about this book is you manage to meld medical detail with pretty good storytelling if I might pay you that compliment. Where did you learn to do this? Most doctors have trouble expressing themselves verbally, let alone on paper.
DR. JEROME GROOPMAN: I just more or less taught myself. The original writing I did was pretty bad. And a few friends, "oh, it's wonderful, it's wonderful." And my wife said, "it's awful." And she said just write simple, declarative sentences and don't use a lot of jargon. And that's pretty much what I've tried to do.
GWEN IFILL: But how do you... I guess I wonder how you do that, because to make any kind of medical explanation understandable to the layperson is more than a notion.
DR. JEROME GROOPMAN: What I try to do in my mind is to speak with my prose the way I would want to explain to a patient and his family what is happening to them, or what's happened in other cases. And it's so critical to make it clear and to make it accessible. And I think that in a way, this writing has made me a better doctor.
GWEN IFILL: In what way?
DR. JEROME GROOPMAN: I think it's taught me, first, greater humility, because I've revisited times when I made serious errors. It's also taught me how to communicate better, and communication is the key in terms of medical care.
GWEN IFILL: How does a doctor, a physician this time, guard against making those mistakes, assuming that laypeople read your book and come away with one set of advice about how to respond to this and how to be more aggressive. What can doctors take away as a way of guarding against these kinds of mistakes?
DR. JEROME GROOPMAN: Well, I think all of us as physicians should acknowledge our fallibility, our limits. We should learn to listen better, because good listening is the beginning of good thinking, careful thinking. And I also think we should come off our pedestal a bit and see our patients as partners with us, and look to their intuition so we can do the best job we can for them.
GWEN IFILL: I found it interesting in your book, you tell the story of one man who had a chance to get an experimental drug and didn't get it, and thought this was his death sentence. Ultimately the experimental drug would've been his death sentence. How quickly is medicine moving in ways like this that you can't even know which direction you should be heading in?
DR. JEROME GROOPMAN: It's moving very, very quickly. And in that particular case, it's what's called the Pygmalion Syndrome. You have to be careful, because all researchers, including myself, fall in love with their own work. And you need some distance from that, so that if you're looking-- like that man was, at an experimental therapy-- you should get an independent assessment of the treatment from a researcher who's not directly involved in the project.
GWEN IFILL: Do you find yourself now with your writer hat on, your doctor hat on, your patient care hat on, your researcher hat on, finding ways to always take what you learn every day and put it on paper? Are people afraid around you to make any mistakes for fear you might start scribbling it down?
DR. JEROME GROOPMAN: Well, I carry index cards in my pocket, and I write thoughts during the day, but I never write about anyone if he or she doesn't want to be written about. And some patients have said, "I don't want to be a chapter in your book." And I say, "you're not." So I respect that. But I think there's an incredible world in medicine. It's both exciting and a time of great hope in terms of research. But as you say, it's not a perfect world. And the more knowledge that's shared with patients and their families, the better the outcome.
GWEN IFILL: Dr. Jerome Groopman, the book is "Second Opinions." Thank you very much.
DR. JEROME GROOPMAN: Thank you.