eSkeptic reviews How Doctors Think 

Remember Jerome Groopman’s  How Doctors Think? In this rather devastating review (via A&L Daily), Charles Lambdin writes about one important problem with the book:

The problem is, this does not tell us anything about how doctors think, only how they think they think.

What is more important,  he also tells how the available research indicates that the solutions prescribed by Dr. Groopman, are in fact not effective:

Unfortunately, what research Groopman cites to back his claims is somewhat one-sided and sometimes off the point. Two articles he cites both argue that decision aids pertaining to treatment (rather than diagnosis) don’t take into account when patients have multiple illnesses requiring multiple medications, which may interact with each other. This is an important point, but to attempt to argue from this single issue that decision aids shouldn’t be relied on is to make a rather specious generalization.

Most doctors do not like decision aids. They rob them of much of their power and prestige. Why go through medical school and accrue a six-figure debt if you’re simply going to use a computer to make diagnoses? One study famously showed that a successful predictive instrument for acute ischemic heart disease (which reduced the false positive rate from 71% to 0) was, after its use in randomized trials, all but discarded by doctors (only 2.8% of the sample continued to use it). It is no secret many doctors despise evidence-based medicine. It is impersonal “cookbook medicine.” It is “dehumanizing,” treating people like statistics. Patients do not like it either. They think less of doctors’ abilities who rely on such aids.

Here is the final paragraph of the review:

Groopman makes comparisons to the perspicacious (and fictitious) “deductions” of Sherlock Holmes. Such comparisons are disingenuous. Most medical patients are not unique mysteries with atypical solutions (though the anecdotes in Groopman’s book are). Accuracy under uncertainty often boils down to what types of errors one is willing to make: a few false negatives with exotic conditions, or a great many “zebra-chasing” false positives. Oddly, Groopman rebukes doctors guilty of “zebra retreat,” but bungles the example this term is derived from. He quotes: “When you hear hoofbeats, think about horses, not zebras.” The actual lesson is, “When in Wyoming, if you hear hoofbeats and think you see stripes, it’s still probably a horse.” Groopman scoffs at this, which is unfortunate because treating every patient as a uniquely rare case will only increase error over time. When one looks at the research Groopman largely ignores, the lesson is clear. Medicine needs to become more science and less art.

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