Groopman/Crichton on MDs as Cognitive Misers

At the NY Times, Michael Crichton reviews Jerome Groopman’s new book, a compilation of his medical essays from the New Yorker. Crichton’s review is worth reading, and two themes familiar to Framing Science readers stand out from his discussion of Groopman’s view on modern medicine:

a) Just like the public, as part of human nature, Doctors are cognitive misers, constantly looking for short cuts and heuristics to cut down on the complexity of diagnosis and medical decision-making. Relying on heuristics is not always bad, writes Crichton and argues Groopman.

Groopman also discusses physician heuristics — shortcuts to decision-making that he considers “the foundation of all mature medical thinking,” although they too “can lead to grave errors.” But Groopman points out that heuristics aren’t taught in medical school and are in fact discouraged, in favor of a much more leisurely and extended kind of thinking, typified by Socratic dialogue between students and professors. This means that young doctors enter the hospital knowing little about either the advantages or the disadvantages of heuristics. Take, for example, what psychologists call “availability,” the tendency to judge the likelihood of an event by how readily it comes to mind. Thus physicians may mistake symptoms of one disease for those of another disease they’ve seen more often. Or they may fall prey to “confirmation bias,” which leads them to rapidly assemble information into an accurate diagnosis — or misconstrue the evidence before them.

b) Doctors, like many scientists, remain poor communicators, unskilled at the very important art of doctor-patient communication. Incorporating research in the area, and partnering with social scientists studying the topic, would assist medical schools in improving this aspect of the profession.