I visited my doctor the other day. Expecting a bit of a wait, I took along Critical Thinking, a textbook for one of my courses. When I walked into the doctor’s office, he read the title and said, “Hmmm … critical thinking. What’s that?” I thought, “My doc just asked me what critical thinking is. This can’t be a good sign.”
I quelled my qualms, however, and explained what I teach in critical thinking class. He brightened up immediately and said, “Oh, that’s just like How Doctors Think.” I pulled out my Kindle and downloaded the book immediately. Understanding how doctors think might actually help me get better medical care.
So how do they think? Well, first they use shortcuts. They generally have way too much information to deal with and use rules of thumb called heuristics. Sound familiar? I’ve written several articles about rules of thumb and how they can lead us astray. (Just look for “thumb” in this website’s Blog Search box). So, the first answer is that doctors think just like us. Is that a good thing? Here are some errors that doctors commonly make:
Representation error — the patient is a picture of health. It’s not likely that those chest pains are a cause for concern. With this error, the doctor identifies a prototype that represents a cluster of characteristics. If you fit the prototype, fine. If not, the doctor may be diagnosing the prototype rather than you.
Attribution error — this often happens with negative stereotypes. The patient is disheveled and smells of booze. Therefore, the tremors are likely caused by alcohol rather than a hereditary disease that causes copper accumulation in the liver. That may be right most of the time but when it’s wrong, it’s really wrong.
Framing errors — I’ve read the patient’s medical charts and I see that she suffers from XYZ. Therefore, we’ll treat her for XYZ. The medical record forms a frame around the patient. Sometimes, doctors forget to step outside the frame and ask about other conditions that might have popped up. Sometimes the best approach is simply to say, “Let me tell you my story.”
Confirmation bias — we see things that confirm our beliefs and don’t see (or ignore) things that don’t. We all do it.
Availability bias — if you’re the 7th patient I’ve seen today and the first six all had the flu, there’s a good chance that I’ll diagnose you with flu, too. It just comes to mind easily; it’s readily available.
Affective bias — the doctor’s emotions get in the way. Sometimes these are negative emotions. (Tip: if you think your doctor feels negatively about you, get a new doctor). But positive emotions can also be harmful. I like you and I don’t want to cause you pain. Therefore, I won’t order that painful, embarrassing test — the one that might just save your life.
Sickest patient syndrome — doctors like to succeed just like anyone else does. With very sick patients, they may subconsciously conclude that they can’t be successful … and do less than their best.
The list goes on … but my space doesn’t. When I started the book I thought it was probably written for doctors. But the author, Jerome Groopman, says it’s really for us laypeople. By understanding how doctors think, we can communicate more effectively with our physicians and help them avoid mistakes. It’s a good thought and a fun read.