(Maybe) How Keith and Shaleah Think

I just finished Dr. Jerome Groopman's How Doctors Think, a thought-about-thought-provoking look at the puzzle doctors face in trying to make correct diagnoses. I enjoyed the book - it read like a mundane version of House, minus all the insults and clear ethical violations. Mainly, the book is a catalog of cognitive errors that doctors can make - availability error, search satisfaction, overreliance on Occam's (Groopman spells it Ockham's) razor, etc. The book offers lots of handy doctorish sayings for dinner parties - "when you hear hoofbeats, think horses not zebras" - but often Groopman shows why these saying can be dangerous, since maybe the doctor is looking at one zebra in a hundred horses. But as Groopman recounts tales of misdiagnosis, it shows the art, rather than science, of being a doctor - a point Keith has made to me many a time. While the book may lead the lay reader (which is its target audience) to believe doctors are just flailing away in the dark, Groopman seems simply to be advocating for openmindedness on every case and the courage (or maybe just the time!) to question initial assumptions.

While legal issues are a small part of the book, one always is aware that any misdiagnosis can lead to a malpractice suit. But Groopman isn't crucifying doctors for being wrong. He is simply taking them to task for thinking they can't be wrong or not being willing to change course when it becomes clear that they are. Nothing in this book is ground-breaking. None of the wisdom or warnings about cognitive errors would be news to doctors, but Groopman shows how the current medical system - predicated on speed of appointments, avoiding expensive tests or (horror!) redoing those tests, and the constant marketing of drugs and surgical devices - can make avoiding cognitive errors almost impossible.

Having said all that, I don't think I could cut it as a doctor. There is too much that is unknown, too many things that could be happening unseen and consequences that are too serious if things go wrong. I've come to believe that almost everything - including, in many cases, the law - is a game (the book How Lawyers Think would be boring, incomprehensible, focused on winning verdicts rather than justice, and ultimately pointless), but being a doctor is not a game. It is very important work. Throughout my reading of the book, I could not help but compare the analysis that Groopman was doing with what I would think in the same situation. (On the first day of law school they say they are going to change the way you think, and I have to admit that they are right.) But I'm not sure if the way I think is helping anyone particularly (or ever will), but I know that the way Keith and Shaleah think is helping some thankful Nebraskans.

Sometimes thinking about thinking can leave one wrapped in a confusing puzzle of meta-ness, but it is a worthwhile exercise. I know I took some things from Groopman's book that will help me make better decisions. I'm expecting that those decisions won't involve life and death, but for those who do make such decisions, remember, zebras do exist!