Second Opinions

Second Opinions is about difficult decisions and when to trust a doctor's judgment. Each of the eight well-told stories is a meditation on how to negotiate the uncertainties of medicine. Groopman is excellent at explaining difficult issues in simple ways, and each case is fascinating. The points he makes are also well considered and useful. As with his previous book, The Measure of Our Days [reviewed in Metapsychology, September 1998] his writing is compassionate and thoughtful. This new book might help give people the courage to question the pronouncements of experts and trust their intuition.

Most of the cases are non-psychiatric, but one is about his grandpa Max, who was showing signs of dementia. Max's doctor did a perfectly good job diagnosing Alzheimer's, but what Groopman remembers most about that difficult time was he doctor's cold indifference to the needs of the family. When Max was to be taken from the hospital to a nursing home, the doctor failed to notify the family when transfer would take place. Max was taken to a strange place on his own, and of course he was frightened and disturbed. His daughter blamed herself for not helping her father more. Groopman blames the doctor for not taking the trouble to be more sensitive to the emotions of his patient.

Other cases deal with Groopman's own patients and his interactions with his peers. He notes how defensive some doctors become when their opinions are questioned, and let their pride come before the health of their patients. One of the recurrent themes in these stories how good physicians should welcome the opportunity to learn from colleagues and work with others to maximize their patient's chances of recovery from serious illness. In another case he has to fight with an HMO in order to get funding for a more experimental treatment for his patient's cancer. The irony is that the HMO was ready to pay for standard treatment, which was just as expensive as the experimental treatment. As with so many stories we hear about HMOs, what is so disgusting is not just the translation of human life into monetary value, but the massive stupidity of the decisions made. I hope to see future books by other authors detailing the mismanagement of health care by HMOs.

Groopman's strength as an author is his ability to capture the little details and deliver a clear moral through his stories. Nevertheless, he spends little time discussing more general issues, and he can hardly avoid the fact that his stories are unusual. Most people don't have leading researchers on cancer or AIDS as their physicians or in their families. Most of us feel at the mercy of a system that costs too much and leaves us feeling lucky if the physician remembers our name. So while Second Opinions is a powerful book, its implications seem a little removed from the experience of ordinary people trying to work out what to do when faced with difficult decisions. But Groopman does at least provide an ideal at which we can aim.