Wednesday, March 28, 2007

NPR : Groopman: The Doctor's In, But Is He Listening?

· Jerome Groopman is a doctor who discovered that he needed a doctor. When his hand was hurt, he went to six prominent surgeons and got four different opinions about what was wrong. Groopman was advised to have unnecessary surgery and got a seemingly made-up diagnosis for a nonexistent condition.

Groopman, who holds a chair in medicine at Harvard Medical School, eventually found a doctor who helped (Audio). But he didn't stop wondering about why those other doctors made the wrong diagnoses. And he wrote about their mistakes in a new book called How Doctors Think (Excerpt).

"Usually doctors are right, but conservatively about 15 percent of all people are misdiagnosed. Some experts think it's as high as 20 to 25 percent," Groopman tells Steve Inskeep. "And in half of those cases, there is serious injury or even death to the patient."

Why do you think that doctors would be wrong that often?

Well, you know, it's very hard to be a doctor. We're working under tremendous time pressure, especially in the current medical system. But the reasons we are wrong are not related to technical mistakes, like someone putting the wrong name on an X-ray or mixing up a blood specimen in the lab. Nor is it really ignorance about what the actual disease is. We make misdiagnoses because we make errors in thinking.

Errors in thinking...

We use shortcuts. Most doctors, within the first 18 seconds of seeing a patient, will interrupt him telling his story and also generate an idea in his mind [of] what's wrong. And too often, we make what's called an anchoring mistake — we fix on that snap judgment.

Which could be based on the first thing the patient says. It could be based on something on their chart or in their file that somebody else has concluded in the past. It could be anything.

It could be anything. There's very frequently a telephone call that precedes a visit where the first doctor says, 'Oh, you know this is a very nervous woman who's in menopause and the feelings she's having are related to change of life.' And that causes what's called an attribution error or a stereotype and I write about that in the book where a woman saw five doctors. And she said, 'You know what, I really feel these explosions in my body.' And everyone thought she was crazy.

And it turned out that she had a tumor that was producing adrenaline. So every once in a while, the tumor would release this burst of adrenaline which made her jittery and sweaty and nervous. And she was indeed a high-strung person. But she said finally to the doctor who made the right diagnosis, 'I know that I'm a tense individual, but something's different. Something has changed.'

What is some advice that you would give to avoid misdiagnosing in this kind of situation?

Most importantly, I think, the patient and the doctor can partner. These thinking errors are made in the moment. They're made when the doctor is listening to the patient or examining the patient — these snap judgments.

Or not listening to the patient...

Or not listening to the patient. And so a patient or a family member or a friend who knows how doctors think well and how they don't think well can help get the doctor back on track by asking some appropriate questions.


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