Second Opinions: Stories of Intuition and Choice in the Changing World of Medicine

As he so ably demonstrated in The Measure of Our Days, Groopman, a clinician and researcher at the Harvard Medical School, writes expressively and compassionately about illness. In the eight case histories presented here, he beautifully illustrates his strong belief that ""a clinical compass is built not only from the doctor's medical knowledge, but also from joining his intuition with that of his patient."" A well-respected hematologist told Alex Orkin he had six months to live unless he underwent a bone marrow transplant. In the absence of an appropriate donor, a very dangerous unmatched transplant was scheduled. Orkin then consulted with Groopman, who, after repeating many tests and getting to know his patient, concluded that the diagnosis was unclear and the proposed transplant too risky. Groopman intuitively decided to rely on a dictum learned in medical school: in some cases it is preferable to do nothing. Despite one scary bout of pneumonia, Orkin's marrow production increased and he recovered. Some of the other histories don't end so happily, however. One case involved a misdiagnosis of asthma by a managed care physician; by the time Groopman became involved and correctly diagnosed acute leukemia, it was too late. The author is convinced that the money-saving practices of HMOs are causing a loss of quality medical care. He also movingly describes his own experience, in which his infant son nearly died because the pediatrician, a poor diagnostician, apparently overlooked a serious condition. Fortunately, the medical expertise of Groopman and his wife (also a physician) saved their son's life. This is an excellent book by a thoughtful physician. First serial to the New Yorker; second serial to Good Housekeeping. (Mar.)