Doctors and Decision Traps

I found this in the latest Time magazine. It’s the story about why and how Harvard hematologist Jerome Groopman came to write a book called How Doctors Think. The big conclusion: “about 80% of medical mistakes are the result of predictable mental traps, or cognitive errors, that bedevil all human beings.” Here is a list of four big thinking
traps . . . [read]

ERROR 1: I RECOGNIZE THE TYPE

Doctors, like most of us, are often led astray by stereotypes that are based on someone’s appearance, emotional state or circumstances. Thus a homeless man’s disorientation might be quickly attributed to alcoholism when the real culprit is diabetes.

ERROR 2: I JUST SAW A CASE LIKE THIS

“We all tend to be influenced by the last experience we had or something that made a deep impression on us,” Groopman says. So if it’s January, your doctor has just seen 14 patients with the flu and you show up with muscle aches and a fever, he or she is more likely to say you have the flu–which is fine unless it’s really meningitis or a reaction to a tetanus shot that you forgot to mention.

ERROR 3: I’VE GOT TO DO SOMETHING

Physicians typically prefer to act even when in doubt about the nature of the problem. And yet this kind of “commission bias” can lead to all sorts of new problems if the treatment turns out to be incorrect.

ERROR 4: I HATE (OR LOVE) THIS PATIENT

Groopman cautions that emotions are more of an issue than most physicians like to admit. Doctors who are particularly fond of a patient have been known to miss the diagnosis of a life-threatening cancer because they just didn’t want it to be true. But negative emotions can be just as blinding, sometimes stopping a doctor from going the extra mile. “If you sense that your doctor is irritated with you, that he or she doesn’t like you,” says Groopman, “then it’s time to get a new doctor.” Studies show that most patients are pretty accurate in describing their doctors’ feelings toward them.

Much has been written about the subject of thinking traps . . . including by us. I’ll dig some of it out and pass it along in another blog. In the meantime, if you find yourself in a situation where some expert is pronouncing judgment, consider it your duty to ask, why, why, why (at least three times) . . . unless of course that expert is wearing sunglasses and asking for your license and registration in which case . . .

kah

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