Malaysian Scholars Foundation

Field: Medicine
Title: How Doctors Think
Author: Jerome Groopman
Publication: Houghton Mifflin Company
ISBN: 0-547-05364-9
Rating: aaa
Level: Intermediate
Reviewed by: A.S Abd Mokti

This brilliant, myth-shattering piece of work digs into the minds of the physicians (doctors), the processes of decision making and the pitfalls in their cognition which makes them arrive at a right diagnosis or a misdiagnosis. Unlike some other authors of the medical literature, Groopman utilised the narrative style of writing, telling stories of individuals consists of doctors, patients and their family members and also other staff like nurses and how both doctors and patients could help each other in arriving at a cogent diagnosis and to avoid thinking errors.

Suitable for both laymen and healthcare professionals, the book transcends the typical case that physicians from many specialities face in their daily practice, and how by being too simplistic or too wary could do harm to the patients once the wrong diagnosis is made. Quoting real life stories from doctors, patients and their loved-ones, Groopman shows how ‘misdiagnosis is the elephant in the living room’ by summarising the cognitive errors into 3 A’s; anchoring error, attribution error and availability error. Basically, anchoring error is to seize initial symptoms and making snap judgement out of them; attribution error is to stereotype a patient as a complainer and keep attributing benign condition to the patient; and availability error is when physicians simply considers the patient to be fine since the previous patients he/ she have met with the particular symptoms were fine too.

He also outlined the danger of satisfaction of search; i.e. being satisfied once almost all the symptoms can be explained without further analysis of multiple causes, and confirmation bias where an abnormal test result, though minor is instead of seeking explanation and follow-ups was put aside in favour of a more conclusive diagnosis though not explanatory . He also addresses the reality of time-constraints that doctors nowadays face with the increase burden of workloads and the tension that medicine should be cost-effective but safe.

Nevertheless, the author advises the patients to look for 3 C’s in a thinking doctor: communication, critical reasoning of thought process that generated the diagnosis and compassion: denoting respect for a patient’s value and spiritual needs. Three cardinal queries should be asked doctors to make them re-evaluate their diagnosis- “What else can it be?” to avoid the 3 A’s cognitive errors, “Could two things be going on to explain my problem?” eradicates ‘satisfaction of search’ and “Is there anything in my history or physical examination or lab tests that seems to be at odds with the working diagnosis” to safeguard against confirmation bias.

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