How Doctors Think

Once the diagnosis is "eating disorder," a lot of doctors and even many mental health providers scatter - they don't feel qualified to treat these confounding illnesses.

Sadly, some clinicians are all too comfortable with treating EDs, and they shouldn't, because without a broad - and continually updated - understanding of both medical and psychological issues they can do more harm than good.

Patients, and their families, suffer the consequences. We can't get good medical attention because of the psychological symptoms. We can't get good psychological supports because the medical symptoms confuse the issues.

One consequence of all this disconnect is that some people get a diagnosis of an eating disorder before illnesses of other types are ruled out. Cases of undiagnosed celiac disease, diabetic gastroparesis, digestive issues, gallbladder issues...

For a thoughtful look at the anatomy of misdiagnosis - of anorexia nervosa, as it happens, check out this interview of the author of "How Doctors Think"

Our job as healthcare consumers is to be less passive and stop demanding certainties and answers as if clinicians are gods. And clinicians have to let down the cloak of invisibility and say: "we don't know everything." It's okay: no one does.


  1. Absolutely fantastic! I LOVE this man who has just put into cogent words what I've been harping on about for years. I shall not be buying the book because it's set within a different organisational system than I am working with (both as a patient, a carer and a supportworker for the clinicians) but I applaud it. Mind you I am still smiling at the footnote (("I quickly realized that trying to assess how psychiatrists think was beyond my abilities.")) - mine too Dr Groopman.

  2. I may be too cynical to respond here! I did happen to have one of the wiser pediatricians for my children when they were growing. He'd ASK me what I thought something was and he'd actually listen.We'd search for answers together. Even whether an ear infection was better...he'd ask me what I thought before he took a peek.I recall one time when I tried a new procedure [a suggestion in a Mothering magazine] which I gently tugged on my daughters ear so it would drain. I did this when she nursed and several times a day. She'd spit out her antibiotics and was on her 3rd dose with the threat of ear tubes so I wanted her ears to get better. THEY DID! Without the antibiotics.When ever she got a cold I'd tug and her ears were fine. No more infections.
    I had midwives for 2 of my children after the disappointment of hospital birthing. I also found midwives to be very wise and informed. One was a lay midwife with mostly apprenticeship training, yet she held a wealth of knowledge compared to the Drs. I used who BEFORE I decided midway through a pregnancy that I wanted something better for my non high risk births. Today they do try harder to give mother's the best of both.
    My point is that while I know Drs. are only human, I also believe they will not get better unless we expect them to and even then sometimes not! With something as important as a quick response with an ED we either need someone who understands what must be done or we have to find someone who does.I also trust other parents and people who just plain like to think inside and outside the box. I don't care whether you graduated if you have a brain that can actually process information and consider the 'whys' and 'what's the next step'. Meanwhile we are quite blessed to have the internet!

  3. To mary: It is absolutely fantastic that you got such wonderful care for your children! I beleive that working with a doctor is improtant and it is also important not to take everything a doctor says as absolute fact. I'm in college, and I find that a lot of my friends use doctors as the end all and be all of information regarding their health. I'm trying to encourage my friends to be proactive in their healthcare which will help them later in life. I wonder how many young people take this attitude.

  4. lili, It's really hard changing the way others do things but it's certainly worth a try at your young age. This is a time when responsibility is transfered from parents to yourselves and many kids never had to think about why they feel a certain way or what they might think is wrong. Many adults/parents still don't look for answers beyond what the Dr. says.
    Your wisdom tells me you grew up knowing yourself! Keep taking care of yourself and sharing as you never really know what others are absorbing and saving for when they really need your advice.You know that we need to shop for a Dr. as an informed consumer. Now it's up to them to want the same level of mindfulness in their own life. This is where a high level of tolerance will help you. Ask Laura about living with this!


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