How doctors think
Part 2 of 2
Patients and physicians stand to gain
Dr. Groopman’s deep conviction that understanding how a doctor’s mind thinks and how a doctor can be made to think better can significantly decrease the occurrence of diagnostic mistakes and their severity inspired him to study this issue and to publish How Doctors Think. He writes: “Doctors desperately need patients and their families and friends to help them think. Without their help, physicians are denied key clues to what is really wrong.”
How can patients, their families and friends make a doctor think better? He offers the following questions with which to open a doctor’s mind:
1. What else can it be, Doctor?
2. Could two things be going on to explain my problem?
3. Is there anything in my history, physical examination or laboratory tests that seem to be at odds with the working diagnosis?
For some twenty years I taught many medical students and young doctors at the University of Manitoba teaching hospitals. These are the types of questions that naturally prevail between medical trainees and medical teachers at the patients’ bedside or teaching rounds. Now I realize more clearly that I had not emphasized enough that patients and parents of sick children should have been similarly encouraged to do so more actively.
Meant primarily for non-physician-patients, the book’s central message commends itself to doctors. Journalism Professor Sheila Solomon Klass of New York University echoed, “Every reflective doctor will learn from this book and every prospective patient will find thoughtful advice for communicating successfully in the medical setting and getting better care.”
Why patients fear to ask
Effective doctor-patient communication is as important in enhancing a doctor’s understanding of her or his patient’s illness as it is in establishing a good doctor-patient relationship. Yet, it is not uncommon that patients hesitate to ask questions of their doctors for fear of embarrassment. Might they ask the wrong question? Might they be perceived as not trusting their doctors? Might they be seen time-insensitive to the other patients in the waiting room? How could patients or parents of child patients, aware of others in the waiting room for whom the doctor is already behind schedule, not hesitate to engage the doctor in more dialogue? I had been a patient myself and I assure you I had these apprehensions, too.
Always young in a doctor’s mind
Let me assure you, however, that I only know of fellow physicians who would truly like to engage their patients in discussion of their ailments. Indeed, doctors are humbly filled with awe when they correctly diagnose what ails the human body. They feel honoured being trusted to give the treatment advice and remain forever grateful for helping someone recover from a difficult illness. These things remain young in a doctor’s heart and mind. That’s why doctors dread to make mistakes in diagnosis. That’s why doctors would welcome questions from their patients.
Nothing to fear
Truly, we as patients have nothing to fear when thinking of asking our doctors some questions. We could even request that they use simple language, not scientific jargon, when answers are given. We as doctors know the healing value of such patient-doctor conversation.
What we should fear is over-reliance on new specialized equipment or rigid use of statistics and numbers. They have, on occasions, led to a wrong diagnosis and choice of treatment because a doctor’s mind had not been challenged enough to think creatively and objectively.
As patients, we should play a crucial role in the making of our own genuine diagnosis, not just any convenient one that comes easily to a doctor’s mind. Our health and life are at stake. It serves well to remember and trust that our doctor’s reason for being is to improve our health and life.
Momentum of interest
The increasing attention given to cognitive errors during the last two decades is good news. Also good news is the overwhelming interest on the part of doctors, nurses, other allied health care professionals, health educators and administrators to know the “genesis of misguided care” and to improve the accuracy of medical-decision making. Policy-makers – both professional body and government – have a natural duty to be more engaged, to devote the needed attention and resources to sustain it, and to continually think of what else could be done to keep the momentum of interest going.
A master key to a doctor’s mind
“What else can it be?” A wise and reflective physician – whether at the clinic or at the emergency room – would do well to listen, pause and think more deeply upon hearing this query to avoid pitfalls in clinical thinking. As patients or parents of sick children, this question is our magic key to open a doctor’s mind.
The Honourable Dr. Rey D. Pagtakhan, a retired lung specialist and University of Manitoba Professor of Pediatrics and Child Health and former Member of Parliament and senior cabinet minister, is widely published and has lectured in Medicine and Politics. He has been the recipient of several honours and awards, including the honorary Doctor of Science and Doctor of Laws, and is listed in the Canadian Who’s Who.