How DO Doctors think? While contemplating my essay for my entrance application to osteopathic school, I wondered. After a short search, I discovered I wasn’t the only one who wanted to know. I found some wonderful books and started with Dr. Jerome Groopman’s book entitled “How Doctors Think”. I was fascinated to learn that medical thought processes are an ongoing area of study. I was stunned to realize that more of the doctor’s emotions play into our decision making that I first thought. Now keep this in mind. While I graduated from Bastyr University just last year with an N.D., I have been and L.P.N. for 17 years now, a nurse’s aide for 1 ½ years before that, and an Air Force Security Police officer before that. I thought I was familiar with how emotions affect decision making. I knew there was a link. I did not know it affects medical decision making as much as research suggest it does. I was also surprised to learn that many patients can tell if their doctor doesn’t like them. Many of these patients also don’t look for a new doctor. I find this surprising since the doctors interviewed said they would get a new one right away.
The sickest patients are the patients least liked by doctors. Furthermore, these patients can sense this (P.19). Well, that can’t be helping patient doctor communications. How comfortable can it be to try to talk to someone about your personal health issues when you feel the person you are talking to doesn’t even like you. They go on to explain that, like everybody, doctors have their own issues and biases. As doctors, we have our own fears and personal issues. Doctors like wins as well. Dr. Groopman interviews a doctor who cared for a woman who had suffered for years with health problems. She had been diagnosed as anorexia nervosa and was written off as a psychiatric case. Finally, at 82 lbs. (37.2 kg) she goes to see Dr. Myron Falchuk. Her doctors have told her she is sick due to anorexia and don’t believe she’s eating. She insists she is. Not only does Falchuk remember Osler’s words that “if you listen to the patient, he is telling you the diagnosis” but he also believes that when you stop following the patients story you aren’t really acting as a doctor. Dr. Falchuk did what several doctors have taught me to do. He retook the case. Start from the beginning of the story. For the moment, he disregarded all the notes in her chart explaining that she was a patient with anorexia. Notes claiming she isn’t eating the 3,000 calorie diet she insists she is. He then reexamined her and didn’t isolate his exam to the repeatedly examined abdomen. An endoscopy showed that the 3,000 calorie diet (consisting of pasta and bread) wasn’t increasing her weight because she had celiac disease. If he had fallen into the emotional trap that this was a non compliant patient, he might not have given the patient the benefit of the doubt.
She had been labeled with many of the medical terms that I believe cause doctors to tune out patients. Neurotic, non-compliant, unimproved. She was misdiagnosed. Dr. Groopman goes on to explain that 15% of medical diagnoses are wrong. Most of the time, a knowledge deficit wasn’t the cause. It was because information that didn’t fit the diagnosis was ignored. Dr. Groopman also goes on to discuss, throughout the book, how the doctors who strive to provide the best care are the ones who look at their own errors. He cites numerous examples of physicians who, when faced with their own mistakes, bail out on the patient. They become unavailable; transferring the patient’s care to someone else, often at a time when the patient is really vulnerable. The doctors Dr. Groopman interviewed, had instead made a habit of making themselves accountable, reassessing their own actions and attempting to learn from their mistakes. When in doubt, keep an open mind.
