Jerome Groopman, MD and Pamela Hartzband, MD

A doctor is humbled about chronic pain

Physician

November 26, 2013

We recently spoke with Jill Marshall, MD (name changed to protect identity), who works as an internist. “I unfortunately became a patient when I was 55-years-old,” she told us, “and I was diagnosed with breast cancer, a disease I had always feared I would get.”

Dr. Marshall was found to have multifocal disease and underwent a right mastectomy and lymph node dissection.

“Ever since I had seen mastectomies when I was in training, …

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A doctor is humbled about chronic pain

Physicians gain unique insights when they become ill themselves

Jerome Groopman, MD and Pamela Hartzband, MD

Physician

June 9, 2013

As physicians, we are all privileged to share with our patients the experience of illness, helping to inform and guide. When we as physicians become ill ourselves, we face unique challenges and gain unique insights. This column will explore those dimensions of experience, when doctors become patients.

We recently spoke with Robert S. Brown, MD, FACP, associate professor of medicine at Harvard Medical School and attending nephrologist at Beth Israel Deaconess …

I teach the anchoring error, but I couldn’t avoid it myself

Jerome Groopman, MD and Pamela Hartzband, MD

Physician

November 2, 2012

We recently spoke with Nayan Kothari, MD, associate dean for education, chair and program director of the department of medicine at Drexel University College of Medicine/Saint Peter’s University Hospital in New Brunswick, N.J. He is 74 years old with long-standing spinal stenosis. He told us that his condition did not prevent him from biking and hiking regularly, and he was otherwise in good health. His medications included baby aspirin, atorvastatin …

Why do patients often deviate from their advance directives?

Jerome Groopman, MD and Pamela Hartzband, MD

Physician

September 24, 2012

One of the most difficult decisions that patients, families and physicians face involves end-of-life care. The advance directive or “living will” has become an accepted framework for patients to delineate their own preferences about what treatment they would or would not want when faced with a life-threatening disorder. But it was not always this way.

In the past, physicians and families often shielded those with potentially fatal illnesses from candid conversations …

Three major cognitive errors physicians make

Jerome Groopman, MD and Pamela Hartzband, MD

Physician

October 9, 2011

As physicians, we all dread missing a diagnosis: indigestion that turns out to be angina, back pain that signals an aortic aneurysm, migraine that proves to be a brain tumor. Although it is only an estimate, several studies in the medical literature indicate that misdiagnosis occurs in 15% to 20% of all cases, and in half of these, there is serious harm to the patient.

Researchers have found that the vast …

The decision to pursue a rare illness

Jerome Groopman, MD and Pamela Hartzband, MD

Conditions and Diseases

October 1, 2011

Patricia Daly, FACP, of Warren Memorial Hospital in Front Royal, Va., told us about the case of a 49-year-old man who presented with marked weight loss. A year prior, the patient had weighed about 220 pounds and intentionally put himself on a diet, but after losing 45 pounds, he developed poor appetite and early satiety.

He continued to lose weight to a nadir of 143 pounds. He found it increasingly difficult …

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The decision to pursue a rare illness

How anchoring leads to misdiagnosis

Jerome Groopman, MD and Pamela Hartzband, MD

Conditions and Diseases

February 10, 2011

Anchoring refers to the tendency to latch on, or anchor, to the first symptom or bit of data and fail to consider the full spectrum of information, leading to misdiagnosis. Recently, we have received several cases where an anchoring error was triggered by a mistake in translating the patient’s words into clinical terms.

Case study #1

Henry Solomon, FACP, currently the medical director of Pfizer Global Pharmaceuticals, was for many years a …

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How anchoring leads to misdiagnosis

Social prejudices may limit the accuracy of patient information

Jerome Groopman, MD and Pamela Hartzband, MD

Patient

December 9, 2010

Raghav Govindarajan, ACP Associate Member, a neurology resident at the Cleveland Clinic Florida, told us about a case he saw in India that has important lessons for clinicians everywhere. The patient was a 65-year-old man who presented with chronic symptoms of burning discomfort and weakness in his left leg.

His symptoms had started about seven years prior and he had been told that he had “neuritis.” He reported that he had …

Multiple assessments are needed in the face of repeated testing

Jerome Groopman, MD and Pamela Hartzband, MD

Conditions and Diseases

September 6, 2010

At a recent weekly case conference at our hospital, we heard about a young woman with an elevated testosterone level. The patient was evaluated by James Hennessey, FACP, prior ACP governor from Rhode Island and currently director of clinical endocrinology at Beth Israel Deaconess Medical Center, along with an endocrine fellow, Laura Sweeney, MD.

Case study: Polycystic ovarian syndrome suspected

The patient was a 19-year-old art student at a local university. She …

Attribution error in a patient with colon cancer

Jerome Groopman, MD and Pamela Hartzband, MD

Conditions and Diseases

August 5, 2010

Zahia Esber, ACP Associate Member, who practices at McKenzie-Willamette Medical Center in Eugene, Ore., told us about a case of a 71-year-old obese woman whose mental status deteriorated rapidly while in the hospital.

The patient had undergone a sigmoid resection in December 2009 for colon cancer. At that time, her mental status was intact. Three weeks after surgery, she returned to the hospital because of nausea and anorexia. She told the …

Diagnosis requires seeing patient problems with a wide lens

Jerome Groopman, MD and Pamela Hartzband, MD

Conditions and Diseases

June 11, 2010

Susan Sorensen, FACP, an internist and hematologist in Palo Alto, Calif., told us of a case where the correct diagnosis took more than a year to make. The patient was a 24-year-old woman who had developed weight loss, fatigue and intermittent chest tightness. She was seen in a local emergency department, and was told that she should consult a pulmonary specialist. A chest X-ray and EKG appeared normal.

Over the next …

Jerome Groopman, MD and Pamela Hartzband, MD

Jerome Groopman, MD and Pamela Hartzband, MD

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