How doctors think

Emerson said that in works of genius, we recognize our own rejected thoughts. This came to mind the other day as I picked up Dr. Jerome Groopman's new book, How Doctors Think, which explores the cognitive processes behind medicine. It's designed for the public, but certainly would be useful for medical professionals also.
I have to admit that for a doctor, this guy writes OK.
I spend a lot of time personally trying to install the medical thinking engine into my medical students.  It's nothing that's easy to write down, and that's why I like to book so much. 
For my students, I describe the diagnostic process, for example, as an intuitive manipulation of probabilities. We teach using case examples, by walking students through a history-taking and a physical examination, asking questions, provoking hypotheses, helping them think through the potential consequences of any action. The whole art of it mostly seems to be passed down person-to-person over the ages.
And it's not easy. That's why I hate the word "misdiagnosis." A diagnosis should be just a temporary concept that we use to make patients better. For example, sometimes when you receive a diagnosis, it's not entirely certain, and we just proceed as if it was in an effort to help allay symptoms and prolong life. Diagnoses in some situations can be picked up and cast away rapidly, and that's how we work. Is the first discarded diagnosis then a misdiagnosis? 

Comments

[paul steffan]

If you take your car in to a brake shop, you'll most likely leave with new brakes. Same principle applies to orthopedic surgeons, chiropractors, and physical therapists.