How Doctors Think – The End

The final chapter of How Doctors Think by Dr. Groopman deals with the experiences of the author (an oncologist by training) and his colleagues as they diagnose and treat cancer patients. This was of special interest to me since I’m considering hematology/oncology as a possible career. The author explains the nuances of dealing with terminal diagnoses. Everything from making the grim but accurate diagnosis to communicating it with the friends, family, and patient him/herself seems to require a special mindset rooted in compassion above all else.

Of course, this is what we would expect, right? We don’t want oncologists bluntly giving out terminal diagnoses… or do we? Groopman explains how it’s important that we find physicians we “click with.” If you’re witty and direct, there’s a physician out there who would appeal to you. If you’re more reserved and timid, there is a physician you can open up to. Likewise, he tells stories where some patients accepted their cancer diagnosis with minimal denial, while others required the aid of family and friends to cope. It all depends on the quality of the patient-doctor relationship and the nature of each patient’s personality/lifestyle. Traits like “bluntness” and “kindness” are all relative.

The Epilogue and Afterword chapters outline a series of questions you should discuss with your doctor to provide you and the physician with a better understanding of the problem at hand. The road to formulating an accurate diagnosis is lined with many paths of cognitive error, but by asking these questions, you can ensure that the physician avoids committing such errors and you become more informed about the condition:

  • “What else can it be?”
    • This will prompt the doctor to pause, think again, and extricate himself from a cognitive trap.
  • Could two things be going on to explain my problem?
    • Occam’s razor (“the simplest explanation is usually the best one”) is something medical students are indirectly thought to believe, and in most cases, this is the case; however, by asking this question, you force the physician to address the pitfall of “satisfaction of search” where the first diagnosis becomes the working diagnosis without ever evaluating other possibilities.
  • “Is there anything in my history or physical examination or lab tests that seems to be at odds with the working diagnosis?”
    • This will safeguard against “confirmation bias.” Confirmation bias occurs after the physician has an initial diagnosis. Any symptoms which do not coincide with this initial diagnosis will simply be brushed off as irrelevant rather than being further investigated.

All in all, How Doctors Think was a fantastic book that I’m glad I read before starting medical school. Next I’ll be reading Complications by Dr. Atul Gawande which was a gift kindly given to me by Oscar.

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