Jerome E. Groopman, MD wrote the book How Doctors Think in 2008. I saw Dr. Groopman interviewed on the PBS Lehrer Report shortly after this book was published, and I was fascinated by his reasons for writing it…so much so that I promptly bought the book and read it.
He related how, in his teaching position at Harvard, he was exposed to many medical students and young doctors in residency training who were very smart and seemed capable during his interactions with them. However, he noticed how quickly they seemed to come to a diagnosis after a very short time to consider the clinical picture of any given patient. These soon-to-be practitioners would “anchor in,” as he put it, and have the diagnosis made without any consideration of other possibilities. This type of reasoning is also referred to as “silo thinking” and failing to think laterally for other options.
He also hurt his hand while swimming and it failed to get better after a considerable amount of time. He experienced excruciating pain while typing on his laptop or writing for any reason. He saw multiple practitioners to try and get help. On one occasion, he was sitting in the exam room with his wife (who is also a medical doctor) and the hand surgeon came in the room with his resident, viewed the x-rays, said that arthroscopy needed to be done, and stated that the resident would put him on the surgery schedule. When asked what would be done, the world-renowned surgeon replied that he would “figure it out” when he got in there. Needless to say, Dr. Groopman kept seeking out opinions until a younger hand surgeon had him get x-rays with both hands in a certain position and made the diagnosis. The young surgeon was also honest and stated he had only done one such case before. Dr. Groopman went to a more experienced surgeon and had the problem fixed. In summary, even he (along with his wife) had to navigate the healthcare conundrum in order to get help.
The book is very insightful in its discussion of our current healthcare environment. He ends the book with important questions to ask your doctor when being evaluated for any condition:
- What else could it be?
- Is there anything that doesn’t fit?
- Is it possible I have more than one problem?
These questions help to create an opportunity for your doctor to leave the “anchored in” position and provide an opportunity to think laterally. We are all patients at one time or another, and making the care environment more accepting of questions and further consideration is time well spent.
Jerome E. Groopman has been a staff writer in medicine and biology for The New Yorker since 1998. He is also the Dina and Raphael Recanati Chair of Medicine at Harvard Medical School, Chief of Experimental Medicine at Beth Israel Deaconess Medical Center, and author of five books, all written for a general audience. He has published approximately 150 scientific articles and has written several Op-Ed pieces on medicine for The New York Times, The Washington Post, and The New Republic.