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

by Derwood Hunsdale-Talbot on July 25, 2009

Review by D.B. Lee

how-doctors-thinkPity the poor physician. Compelled above all to “first, do no harm,” when experience shows him or her that doing harm is almost a necessary consequence of good doctoring. As patients, we expect our physicians to be inerrant, knowledgeable of every new study and healing technology. We also expect them to be deeply empathetic, sympathetic and to care about our case like it’s the only one that really matters.

This book shows us that doctors are of course, merely human, subject to exactly the same pitfalls of thinking as the rest of us. Studies are cited showing that as many as fifteen percent of all diagnoses are inaccurate. The average diagnostic error rate in interpreting medical images is in the twenty to thirty percent range. (In one case, when a single radiologist reread on a later day the same sixty films, he contradicted his earlier analysis from five to ten percent of the time.)

It’s not that doctors don’t know their stuff. A study of one hundred incorrect diagnoses found that only four were due to inadequate medical knowledge. Like most of us, doctors are subject to influences such as confirmation bias, our tendency to see only the evidence that supports our current opinion and to ignore or disparage information that doesn’t fit that opinion. Add to this the common nature of most of our maladies and you can see why most physicians routinely prescribe only about two dozen drugs.

So this book is how to be a better doctor, by learning how easily one can be deceived by our own biases and how to develop finer critical thinking skills. As Dr. James Lock says, “Epistemology, the nature of knowing, is key in my field. What we know is based on only a modest level of understanding. If you carry that truth around with you, you are instantaneously ready to challenge what you think you know the minute you see anything that suggest it might not be right.”

Perhaps more important, the book teaches us how to be better patients. We learn when and how to question our physicians, how to best explain our health concerns and symptoms, how to insist on thorough explanations. In this last point, we are reminded by Dr. Linda Lewis: “There is nothing in biology or medicine that is so complicated that, if explained in clear and simple language, cannot be understood by any layperson.”

How Doctors Think takes Dr. Lewis’ advice, using “clear and simple language” to highlight ways modern medicine can be significantly improved.

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