Thursday, December 6, 2007

What else could it be?


Dr. Jerome Groopman's analysis of human cognition in medicine is outstanding. Here are my comments on this book to encourage you to read it:

In How Doctors Think, Groopman deconstructs human thinking and decision making. According to Groopman, employing heuristics and making attribution errors represent two common cognitive blunders that people make regularly. In medicine, physicians tend to anchor to initial information, use snap judgments, and cut corners in thinking - all heuristics. 

Initial information frames our thoughts and then strongly guides where our minds work and what conclusions we develop. For example, a patient in this book, Anne Dodge, had seen more than twenty doctors for her weight loss syndrome. For fifteen years, doctors labeled her as an anorexic even though she claimed that she tried to eat but her body could not take food. Then, finally, someone suggested that she see a gastroenterologist. This doctor proceeded differently than previous ones did. This doctor asked himself a key question, "What if she is telling the truth?" Soon, he discovered that she had celiac disease - allergy to carbohydrates. 

This case illustrates one of Groopman's main points for his book: patients can help with their diagnoses by recognizing thinking errors. Heuristics are short cuts in thinking, and patients can ask appropriate and focused questions so that their doctors do not take thinking detours. For instance, patients can ask: "What else could it be?" or "Could two or more things be going on simultaneously?" In reality, error rates are high in many human endeavors, such as medicine, because imperfect human brains try to process inaccurate and incomplete information. Thus, people must always employ healthy skepticism: ask questions!

Finally, attribution errors - stereotypes - inhibit our minds from thinking more generally; they cause us to tunnel within predetermined frameworks. Therefore, we have to monitor ourselves, be professional, and continue searching while thinking and making decisions in medicine in order to keep our minds fresh. We must always keep asking, "What else could it be?" This application of empirical skepticism can help doctors and patients communicate more effectively, and it also provides insight on how to juggle the paradox of searching versus acting: the search never ends!  

P.S.  Building on my previous post, note the similarities between how the gastroenterologist treated Anne Dodge and how the Good Samaritan treated the injured man in Jericho. In both cases, epoche - "suspending judgment" - informed how these compassionate people responded.


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