Shot in the dark: why doctors know less than you think.

• Author: Brownlee, Shannon
• Position: How Doctors Think - Book review

How Doctors Think By Jerome Groopman Houghton Mifflin, 320 pp.

When Anne Dodge was twenty years old, food suddenly stopped agreeing with her. She would get hungry, she would eat, then a feeling like something gripping her stomach would come over her, and she would retreat to the bathroom to vomit. Suspecting a mental disorder, her primary-care physician referred her to a psychiatrist, who diagnosed anorexia nervosa with bulimia. But despite weekly therapy sessions, Anne continued to lose weight.

As her health deteriorated, she consulted more and more specialists: hematologists because her red blood cell count was perilously low; nutritionists because she was malnourished; orthopedists when she developed osteoporosis. When she began suffering from bouts of constipation alternating with diarrhea, various gastroenterologists diagnosed irritable bowel syndrome, a disease of unknown etiology and even more uncertain treatment. By the time Dodge was thirty years old, she had seen at least two dozen different specialists. She was put on a 3,000-calorie-a-day diet that consisted of mostly bread and pasta, which she swore she was forcing down, yet her doctors suspected she was lying as she continued to lose weight. By December 2004, Dodge was down to eighty-two pounds and deeply despondent about her condition. At her boyfriend's insistence, she drove into Boston shortly after Christmas Day for a consultation with yet another specialist.

This specialist was different. Before performing a physical exam, Dr. Myron Falchuk, a gastroenterologist at Boston's Beth Israel Deaconess Medical Center, asked Dodge to do something no other physician had requested. "Let's go back to the beginning," he said. "Tell me about when you first didn't feel good." The longer Falchuk observed Anne Dodge, writes Jerome Groopman, "the more he listened to her, the more disquiet he felt." Everyone else had written her off as some neurotic, a mental case who not only wasn't eating enough but lied about it, yet Falchuk's intuition told him the picture didn't fit. And once he felt that way, he told Groopman, "I began to wonder: What was missing?" As it turned out, Dodge did not have anorexia nervosa, or bulimia, or irritable bowel syndrome. In asking this young woman simply to recount her story, Falchuk was able to come to the diagnosis that had eluded the specialists who came before him. He was able to restore her to health.

In telling Falchuk's tale, and those of other...