Uncertainty in How Doctors Think

Dr. Jerome Groopman's book, How Doctors Think, draws upon extensive research, interviews with the nations most esteemed physicians and surgeons, and his personal experience in the medical field in order to examine the question addressed in the text's title.  Groopman's use of various sources adds to his credibility; we are able to see the many perspectives of our health care providers. He admits that the act of providing medical care is essentially a performance, that doctors, even when uncertain in their evaluations of a patient, must present themselves in a professional, credible, and most important, in a confident way, so that the patient is able to put their trust in them. He comments on his experience as a resident at the Phillips House of Massachusetts General Hospital during the 1970s: "A few of [the physicians at Philips House] were highly skilled, but several were, at best, marginal in their clinical acumen." (I had to look up the word "acumen," which my computer dictionary defines as "the ability to make good judgments and quick decisions, typically in a particular domain") So, being well-learned is only half of the battle.  A critical skill that doctors must have is the ability to make decisions and judgements pretty much instantaneously.  When a patient enters a hospital in critical condition, there is often not enough time to explore different options for treatment, so a doctor must make a fast decision.

In his discussion of the availability heuristic (enabling a person to discover or learn something for themselves), or the "hands on" approach, Groopman explains that in making a diagnosis, many doctors are partial to the cases they see most often.  This is dangerous, since categorizing disease on a macroscopic level (using general symptoms) and using that diagnosis to decide which treatments to provide can lead to adverse, even fatal, effects on the microscopic level.  This is why patients are advised to seek attention from various doctors in order to avoid misdiagnosis and get treatment for a condition that they do not have.

As someone who wants to be a doctor, I found Groopman's book to be very interesting and helpful.  As a doctor, it is inevitable that, on a constant basis, you will be put in situations where you are uncertain.  However, it is your duty to deal with that anxiety,  make decisions that you believe will be best for your patients, and when those decisions prove to be the wrong ones, you will have to find coping mechanisms to deal with that.  Now, from a patient's perspective, you will obviously not be happy when a doctor does not diagnose you or somebody that you love in the right way.  But, this is an unfortunate reality that happens, even when dealing with the most credible of physicians. Both patients and doctors must consider the fact of uncertainty when receiving and providing treatment.