Heroes Not Zombies

Richard Horton has written an excellent review of “How Doctors Think” by Jerome Groopman here.

The main point he makes is that doctors make mistakes primarily because of failures in the ways they think.

Good doctoring is about listening and observing,
establishing a trusting environment for the patient, displaying
authentic empathy, and using one’s skills and knowledge to deliver
superb care. But a neglected aspect of this professionalism is getting
doctors to think about their own thinking. Only by doing so are doctors
likely to reduce the number of errors they make. What should they do?

Here’s a summary of his recommendations in answer to that question –

• Encourage patients to tell and retell their stories. “a critical element of any mutually respectful therapeutic partnership
  that the doctor acknowledges the patient’s version of the truth of his
  or her story.”
• Slow down. “The more time a doctor takes, the fewer cognitive errors he will make”
• Once a decision is made, always retain an element of doubt.

None of these recommendations is in tune with current medical thinking. Doctors are encouraged to make diagnoses on the basis of the results of investigations. The art of listening to a patient’s story to make a good diagnosis even before a physical examination and any tests are run has receded as doctors are increasingly encouraged to treat patients according to protocols and guidelines created on the basis of statistical analyses of what’s measurable (stories are dismissed as anecdotes and unreliable subjectivity). Rather than slow down, health authorities around the world push doctors to see more and more patients more and more quickly. And doubt? Still, young doctors are encouraged to be certain and to believe in the rightness of their decisions. Retaining a healthy amount of doubt would make doctors more humble and more able to recognise when they are not getting it right after all.