How do doctors decide things?
Jerome Groopman, Harvard professor and staff writer for The New Yorker, has written a new book called How Doctors Think. His point is that, among other things, the way doctors make decisions is filtered through our past experiences, what we have seen lately, and what we already know the most about. Heuristics, the formal discipline of problem-solving, is not taught to medical students, at least not widely. Most of us learn, as I did, by the apprenticeship system – watching more experienced doctors and how they operate. This can lead to problems.
One particular problem Groopman points out is that diagnostic decisions have a kind of momentum; once a child is placed in a particular disease category, a diagnostic box, we filter everything through our assumption the diagnosis is correct. I see this happen now and then. We are tempted to ignore any data that contradicts what we “know” to be the diagnosis. Doctors even have a saying to justify this: when something seems strange, we are taught “it’s more likely to be an uncommon manifestation of a common thing than it is to be an uncommon thing.” Perhaps so, but uncommon things still happen.