Monday, April 14, 2008

How Doctors Think, by Jerome Groopman, M.D.

A terrific book. Groopman takes on the task of figuring out how doctors make decisions about treatment. He finds that the majority of medical mistakes come from certain types of thinking patterns that doctors fall into. He offers simple suggestions to both doctor and patient to help the doctors break out of these patterns in particular cases.

Patients and doctors can benefit most by understanding the "three As", as they were termed by one reader:

  • anchoring
  • attribution
  • availability

"Anchoring" is seizing on a set of symptoms, making a snap diagnosis and not looking further

"Attribution" is making assumptions about a patient because of certain patient attributes - old, young, complainer, whatever. In an episode of House the patient was a hugely obese man who insisted that the doctors look past his weight for what was wrong with him. Turns out he was right; the diagnosis was bad but had nothing to do with his weight.

"Availability" is the tendency to remember, in a flash, similar cases and assign the present case to the same group. For example, if the doctor has been treating a number of people with abdominal pains and they all had acid reflux he might jump to that assumption in a similar case because the diagnosis is "available" - frequently used, easy to call on.

I am sure I haven't described these as well as I could. What is critical for patients is to ask some meaningful questions when they feel the diagnosis may not be right for some reason. Here are the questions Dr. Groopman suggests:

"What else could it be?" - this question can break the physician away from a snap diagnosis.

"Could two things be going on at once?" In other words, might there be two problems instead of one?

"Is there anything in my history or the tests that seem to be at odds with the diagnosis?" Sometimes doctors see symptoms that "don't fit" but simply label them "atypical". This question brings those symptoms to the front.

I want to give a copy of this book to the doctor I have seen a few times, the doctor I am starting to consider my primary physician. I think all doctors should read it, and in the case of my doctor I suspect he actually would. It's a great resource, written compassionately and clearly, that does not condemn doctors; instead it can help them be better than they are.

No comments: