Thinking risks and remedies

How Doctors Think

Doctors are in a high stakes business where thinking mistakes have serious consequences. Even with good intentions, expert knowledge and sophisticated medical technology, an average of about 15 percent of a doctor’s diagnoses are wrong – potentially causing patient stress, suffering, physical harm, even death. So what’s the problem? Thinking short cuts, the kind that we’re all prone to make, are undermining good decision making.

In his recent book How Doctors Think, Jerome Groopman uses compelling medical examples to explain these thinking pitfalls and their remedies. At their core is a doctor’s humanity and how emotions influence decisions. Here are a few of his examples.

Attribution errors, where thinking is influenced by stereotypes. The healthy looking, athletic person appears to have no serious problem. Alcoholics, heavy smokers or very obese people may get less attention because of doctors’ judgments about their life style.

Availability errors, where decisions are influenced by recent experiences more than the current patient. After seeing many pneumonia cases, a doctor may tend to diagnose the next patient as having pneumonia too because it is upper most in his/her mind.

Confirmation bias, where you confirm your initial judgment by selectively accepting or ignoring information. Specialists may be particularly susceptible to this when the very depth of their experience tends to narrow their thinking.

Sounds pretty normal, right? We all rush to conclusions sometimes by recognizing patterns or using intuition. But for doctors, these human tendencies can have serious consequences. …

The broader lesson is that people in any information rich field with guidelines, algorithms and expert opinions can still make human thinking mistakes. Whenever there are risks to health, safety or other critical public interests, we must tackle the realities of motivations, emotions and thinking pitfalls directly, not ignore them.

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