How Doctors Think – Part 2

So I’m almost half-way done with How Doctors Think. Impressed? I sure am! 😀 The author made an interesting point in the last chapter – the more specialized the trade, the less likely an error will occur in the diagnosis.

Let’s say you’re a neurosurgeon thirty years into your practice. You’ve seen everything ranging from relatively simple disc herniations to painful trigeminal neuralgias and even elusive brain stem tumors. More often than not, your patients have been referred to you by another doctor, and with your years of expertise, the proper diagnosis is almost always made and relevant surgery(s) is performed.

Now let’s say that your friend sees a barrage of less specialized cases working in family medicine. Patients come in with abdominal pain, headaches, sore throats, etc. These symptoms are far more open-ended, and while Bayesian analysis is frequently utilized for the diagnosis (ie, if a patient presents with a sore throat and fever, they are way more likely to have strep throat than anything else), it’s more likely that the doctor could overlook something more serious.

After all, if a patient has blurred vision and brain imaging reveals a tumor pressing on their optic chiasm, a causal relationship between the tumor and poor vision can likely be established. If a patient has pain in their gut, there are tens of worthy diagnoses which could fit the symptom. If a physician doesn’t keep an open mind in the differential stages, they could tumble down a slippery slope of mistakes.

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  1. … someone is getting paid to write chapters about this? isn’t that kind of obvious? isn’t that the point in specialization? (not to be mean lol)

    you’re making me jealous reading all these books… i wish i had time. have you read “The Doctor?” They made us read that for an ethics class last semester. it’s more of a “remember how the patient feels” kind of thing. but it had a really good story, and had a pretty good point.

    • Lol, “all these books?” I’ve read exactly one book this whole year. 😀 But you’re right. I guess the author’s credentials make people want to side with him, when in reality, it’s common sense.


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