Jerome Groopman, M.D.

On a sweltering morning in June 1976. Jerome gets ready for his first day of internship…Despite the heat he walked along Cambridge street to the entrance of

Massachusetts General Hospital

Phillips

BakerBulfinch

After checking the floor, Jerome went to visit his next patient..

Suddenly! when Jerome was about to leave, Mr. Morgan

was moaning in pain. His eyes enlarged, his chest heaving violently, and he could not talk at all.

I try to think but couldn’t, my index card was no help. My feet was stuck to the floor.

\\ 囧 //OMG

what I’ve heard was not taught in school!!

I was an A student, I feel so helpless!!

COMMENSING

BATISTA

OPERATION

Fortunately, Mr. Morgan survived the surgery…but he is now at a mental hospital after being traumatized by the aggressive nurse who gave him CPR.

If you apply to a medical school…You need to finish pre-medicine academic

courses. (usually 4 years)Your grades need to be pretty excellent.You have to pass the Medical College

Admission Test.You have to pass the interview.

Good job!! Now you are a medical student!!

ResidencyFamily doctors, pediatricians: 3 years Surgeons: 7 years

Congratulations! You are a doctor now!

After you pass the third license exam, you are a doctor now!

Becoming specialists or PhD may take more time to study.

America. Vs. Taiwan1. Pre-medicine

courses2. MCAT and

interview3. 4 years medicine

courses4. 3 ～ 7 years

residency5. Three times

license exams

1. CEE2. 7 years medicine

courses3. 3 years residency4. Two times license

exams

Jerome Groopmana staff writer in medicine

and biology for The New Yorker since 1998

Professor of Medicine at Harvard Medical School

Chief of Experimental Medicine at Beth Israel Deaconess Medical Center

Jerome GroopmanDina and Raphael Recanati Chair of Medicine at

Harvard Medical Schoolone of the world's leading researchers in cancer

and AIDSHe was at the Massachusetts General Hospital

for his internship and residency in internal medicine.

The Measure of Our Days 1997 Second Opinions 2000

Anatomy of Hope 2004 How Doctors Think 2007

Anne Dodge’s case historyShe suffered from stomach ache and vomiting

after she ate for 15 years.Internist’s diagnosis nothingPsychiatrist(精神科 ) anorexia nervosa(神經性厭食症 ) and irritable Colon Syndrome(大腸激躁症 )All doctor focused on the two diagnosis.

Anne Dodge’s case historyHer problem didn’t be solved. However,

worse.Dr. Myron Falchuk question,

listen, and observe. Coeliac disease.

Coeliac disease is caused by allergy to gluten(麵筋 ).

ComparisonIntuition in the

statue doesn’t look right

Spontaneous reaction caused by our brain.

Often without knowledge.

Intuition in the how doctors think

Result from experiment and knowledge in mind.

Must be trained.Being called “pattern

recognition” and “heuristic.”

ComparisonEmotional detachment

in Indian campPut emphasis on the

lack of compassion of doctor

Ex. The doctor ignored the lady’s screaming and didn’t prepare appropriate tools for the operation

Emotional detachment in how doctors think

Put emphasis on the nervousness when dealing with patients’ problem.

Ex. The author was too nervous to do anything for Mr. Mogan.

Anne’s case Physicians had fifteen years to ponder Anne

Dodge’s case Too emphasize on case historyDr. Falchuk successfully cured Anne, why?Avoid the negative feelings/presumptions of

patients.Communicate properly.

Mr. Morgan’s caseIt took Dr. Burnside few seconds to figure out

what was wrong.What’s wrong with the intern?Knowledge?Emotional detachment? (not really)Nervous? (suppressing the panic feeling)

Yerkes-Dodson curve

a state of heightened physiological activity

The major reason of errors made in medicine. -Too nervous. -Affected by inner feelings.

The keys to avoid making mistakes. -Calm down. -Eliminate our inner feelings/presumptions.

Our minds are easily influenced/confused by our senses. Try to stop the moving wheels.

Doctors are still human.

What if the mistake has happened? -Admit the mistake and learn from it. -Show sympathy.