Jerome Groopman, M.D.

On a sweltering morning in June 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 Baker Bulfinch

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!! 1 & 2 grades Lectures Anatomy First exam Basic medicine 3 & 4 grades Rotation Second exam USMLE Clinical skills

Residency Family 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. Taiwan 1.Pre-medicine courses 2.MCAT and interview 3.4 years medicine courses 4.3 ～ 7 years residency 5.Three times license exams 1.CEE 2.7 years medicine courses 3.3 years residency 4.Two times license exams

Jerome Groopman a 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 Groopman Dina and Raphael Recanati Chair of Medicine at Harvard Medical School one of the world's leading researchers in cancer and AIDS He 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 history She suffered from stomach ache and vomiting after she ate for 15 years. Internist’s diagnosis nothing Psychiatrist( 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 history Her 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 ).

Comparison Intuition 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.”

Comparison Emotional detachment in Indian camp  Put 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 history Dr. Falchuk successfully cured Anne, why? Avoid the negative feelings/presumptions of patients. Communicate properly.

Mr. Morgan’s case It 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

Conclusion ……..hang in there, only 20 more slides to go………

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.