Wednesday, August 18, 2010

How Should Doctors Think

How did the book How Doctors Think come to be? Dr. Groopman participated in doing rounds with medical students and residents at the hospital. In the process he realized that the students and residents were relying a great deal on algorithms and evidence-based medicine. If you don’t know what an algorithm is think of a decision tree. You ask certain questions and if you answer “yes” you go on to a certain pre-set question and if you answer “no” you go another way and either stop asking questions or ask an entirely different pre-set question. You continue doing this until you reach a conclusion (diagnosis). This realization caused him to ask himself, “how should a doctor think?” In response he was forced to evaluate his own way of thinking and reasoning.

As an example of how doctors think he relates the true story of a woman who has been repeatedly diagnosed with anorexia and bulimia. Her family doctor finally sends her to a gastroenterologist (GI ). For the first time, this specialist really listens to her story and gives her hope. She has horrible stomach pain, nausea, and vomiting after eating and has been losing weight. She relates what she is eating to the doctor. It actually totals about 3,000 calories a day. Now, the specialist can choose to believe her and explore further to find out why she still isn’t able to gain weight, or he can choose not to believe her and label her with the same diagnosis of anorexia and bulimia. In the end, he believes her and asks “what am I missing”? She has some further testing done and receives the diagnosis of celiac disease. She is allergic to gluten which is found in many grains. After modifying her diet she finally starts to gain some weight and feeling better. This true story shows how a doctor’s thinking can radically affect a situation.

How does your doctor think? Does he/she think like the doctor in the true story?

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