How doctors think

A short while ago, while listening to NPR, I heard about this book, written by a doctor who both teaches at Harvard Medical school and writes for the New Yorker. I bought it expecting a grand revelation, because as I understood it, the purpose of the book is not only to explore how physicians think, but to help them overcome the shortcomings of the heuristics used in practice. The perspective I got was that it was targeted at both physicians and patients.

I was a bit disappointed. Perhaps the fact that I am in medical school, in an environment keyed to understanding exactly the concepts laid out here, makes me more informed that the target audience. Certainly, to a layperson, much in this book might be shocking. But to someone behind the scenes, it becomes a set of anecdotes similar to dozens I've heard in the last four years, interspersed with familiar teaching points: maintain an open mind, listen to the patient, consider all the options. The condemnations are familiar as well: insurance under compensates primary care, insurance doesn't cover enough, doctors leap to conclusions. All of which is true, but not new.

In its defense, the book is probably very good for the moderately informed layman, and rereading the laudatory quotes, I see it is not really intended for a physician audience. Certainly, few patients are familiar with a statistic Dr. Groopman cites early in the book, that an experienced physician reaches a diagnosis within 17 seconds of seeing the average patient. Bon mots like that abound for someone who has seen little or been taught little of the workings of a hospital. And the fact that the author is a writer for one of the better-written magazines of our time is evidence of his style and capabilities with language.

Certainly too, the advice he dispenses to patients may be new, and is valuable. Ask good questions, don't be satisfied with cursory explanations, ask what else besides the diagnosis your doctor has settled on could be the problem.

Overall, I enjoyed the book, but my attention was flagging by the final few chapters as it become clear that the exploration of thought was not aimed at a professional audience. The anecdotes serve as warnings and reminders to me, but no more so than any others I've heard. The exhortations to lateral thinking and open-mindedness are no different than that I've heard from my better attendings. And truly, that probably summarizes what this is: an excellent medicine attending writing out his advice to younger physicians in a format a lay audience can understand. Taken for what it is, on that ground, the book is solid and worthwhile. But fellow med students and physicians: don't bother.