"How doctors think"

Dr Jerome Groopman, chief of experimental medicine at Beth Israel Deaconess Medical Center in Boston and teaches at Harvard Medical School, felt disturbed one day while he was on rounds with a group of interns, residents and medical students. He was concerned the trainees failed to question cogently or listen carefully or observe keenly and wanted to explore what goes on in a doctors's mind as he/she treats a patient.

"How doctors think" is Dr Groopman's findings of the thought processes of doctors and the errors in thinking to which they are prone drawing on a wealth of research, extensive interviews with doctors and his own experiences as a doctor and as a patient. He says that most of the mistakes doctors make are cognitive errors, many use strategies of pattern recognition to make quick decisions and are unaware of their cognitive vulnerabilities that influence their medical judgement.

He tells the story of a young woman who had been assessed and treated by numerous specialists including psychologists and psychiatrists over 15 years, but her health continued to deteriorate. The turning point came when she was referred to a gastroenterologists who was recommended to treat her irritable bowel syndrome with diet and tranquilizers. The gastroenterologist acted differently - he reconsidered her case from scratch, questioning, listening, observing and thinking differently about her illness. He diagnosed celiac disease and saved her life - " for 15 years a key aspect of her illnesses had been missed."

Dr Groopman suggests that if doctors can become more aware of their emotions, prejudices and cognitive processes in reaching a diagnosis, and in particular the role that their first impression plays in that process, they can eliminate many of these errors and can be a better caregiver.

Dr Groopman suggests that patient's story is essential in the diagnostic process because doctors need patients and their families to help provide vital information about their illnesses. Patients need to know how doctors think and ask questions to help doctors refocus their thought in making the right diagnosis.