The 18-Second Doctor
Jerome Groopman knows a thing or two about medicine. A noted researcher on cancer and AIDS at Beth Israel Deaconess Medical Center in Boston and a professor at Harvard Medical School, he also writes about the practice of medicine for the New Yorker. But he had to start from scratch to understand the subject of his new book, How Doctors Think. Groopman explains how faulty thinking by doctors can lead to tragically wrong diagnoses and what patients can do to better the odds of getting the right care.
Why did you decide to look into how doctors make decisions?
I had become aware of misdiagnoses of family and friends. I was teaching three years ago, and I found that many of the students were very smart. But they were latching on to these algorithms, making very quick judgments, and following cookbook-type recipes for diagnosis and treatment. I thought to myself, "How can I teach them to think better? How is it that I have made misdiagnoses, and senior colleagues of mine sometimes miss very important diagnoses?" To do that, I had to understand how doctors think.
You'd think the process had been studied to death.
No, it hasn't. So what I did was begin to interview physicians all across the country and talk to them about their triumphs, when they came to the correct diagnosis, and when they failed. I also very critically examined my own thinking and particularly my own errors.
You tell the story of Ann Dodge, who suffered for 15 years despite seeing almost 30 doctors. They said she had anorexia, bulimia, and irritable bowel syndrome. She developed anemia, osteoporosis, and was down to 82 pounds, even though she was eating 3,000 calories a day.
She was literally wasting away. As physicians, we rely on pattern recognition to make diagnoses, and too often we come to snap judgments. We tend to stereotype patients. You will just rubber-stamp what's been said and done over the past 15 years. And yet here's a doctor, Myron Falchuk, who pushes all that to the side and returns through language to her story. He asks himself one of the key questions, which is, what else could it be? Or could two things be going on simultaneously? He thinks more broadly and makes a diagnosis that had been missed for 15 years. And saved her life. She had celiac disease, an autoimmune disorder that's essentially an allergy to gluten in food.
That doctor really listened to his patient, which is what we all hope for when we walk into a doctor's office.
We want to be listened to, and in a high-tech age, the key to accurate diagnosis and the basis of insightful thinking comes from listening and language. The errors that we make in our thinking often come about because we cut off the dialogue. Most physicians interrupt a patient 18 seconds after they start talking.
Have you had your own experience with the 18-second doctor?
Three years ago, I had very bad pain and swelling in my right wrist. I had been banging away at the computer, my hand got caught in an elevator door when the door closed, so I had some trauma to it. I saw several different prominent hand surgeons and got four different opinions. The third one I saw was basically on roller skates. He breezed into the room, didn't sit down, took about 10 seconds to look at my wrist, and said that he would do an arthroscopy and then figure it out. I asked him what he felt was wrong. He said, "I think it's a form of gout," which frankly didn't make sense. He was rushed and harried and didn't really want to even spend a few minutes explaining clearly why he had made that snap judgment. It was incredibly disheartening. I left.