"How Doctors Think"- a good book

I recently finished reading this book after a really interesting discussion with some friends-of-friends who happened to work in publishing and in clinical psychology.

It was quite the best seller when it was first published in 2007, and was discussed as a book written by a doctor to a target audience of laypersons with the intent of helping to understand how their doctors may think, and thereby how to get the most out of their appointments.

Certainly it is that, but is worthwhile for anyone to read and particularly for doctors.

Dr. Groopman is systematically examining the way in which doctors are trained and practice. He is also looking at how some specific specialties (such as primary care, surgery and radiology) may be prone to certain types of predictable errors due to their training or practice settings.

The book is not an indictment of medical error, but rather a study in technical and human limitation with suggestions for recognizing and remedying such problems.

It is therefore a fascinating book for the patient and family, but should offer reflection and self-inspection for any doctor.

Back to School Special: A Different Way to Rank the Best Schools

We've all seen the U.S. News and World Report annual ranking of top schools since it was first published in 1983. Many students and parents avidly look to see where their university, college, or graduate school falls within the top 100.

It's worth noting that the rankings are based largely on entrance examination scores, amount of funding received for research, and the subjective impression by educators of the overall prestige of the institution.

There has been real interest in looking at the ranking of schools in a different way which is based more on desired outcomes.

For instance, what if the focus was more on how well institutions of higher learning fulfilled their stated missions to graduate enrolled students, prepare them for further education or social service, and to attract and maintain high caliber faculty as well as to do research?

The Washington Monthly did exactly such a ranking which examined research funding, but also successful graduation rates, transition to graduate study, involvement of Pell grants, ROTC and Peace Corps and also the membership of faculty in national academies as recipients of significant awards.

Some rankings based on these criteria are not surprising; Stanford is highly ranked at #4, though really Stanford has always claimed to be serious in the societal aspects of its mission statement.

On the other hand, Harvard placed a lowly #9, while UC San Diego was #1! Not only did UCSD spend more on research than Harvard, but UCSD also surpassed Harvard in successfully graduating students, and in student community service. (Disclosure: my alma mater UC Davis was #6).

A recent study published in the Annals of Internal Medicine similarly looked at the ranking of medical schools in a different light. Rather than ranking med schools based on MCAT scores and what percentage of applicants were turned down, this study ranks by the number of graduates who go on to practice primary care medicine, and particularly under-represented minority graduates and practice in rural or under-served parts of the country. The assumption being made here is that the ultimate goal of a medical school is to produce doctors who will be of the most benefit to the health of our country.

Interestingly, the rankings based on these criteria are nearly opposite the classic rankings based on elite status.

I guess the implication of both these rankings is that students, their families and also the populace in general and our government should consider thinking differently about how we think of our institutions of higher learning and how we want to act on this.