Monday, April 2, 2012

Trusting your gut?

In the first half of How Doctors Think, Jerone Groopman presents several short scenarios illustrating the thought processes of doctors. In the introduction, Groopman tells the story of Anne Dodge. Dodge had symptoms of rapid weight loss and other disorders associated with malnutrition. During the duration of her illness, she had been repeatedly told by different doctors that she suffered from anorexia nervosa and bulimia. Seemingly untreatable, she sought the opinion of Dr. Myron Falchuk. Falchuk was unlike Dodge’s other doctors, and did not diagnose his patient based on her previous charts or textbook algorithms. Instead, Falchuk used a sort of intuition cultivated from years of medical experience. He asked her open ended questions, thought outside of the box, and eventually diagnosed her with celiac disease and saved her life. 
In this situation, Falchuk’s inability to factor in communication cues and other variables not visible on her chart were very helpful in his diagnosis. Strict textbook learned thinking in the form of algorithms would not have led him to the correct diagnosis in this case. Groopman states that in cases such as these, clinical algorithms “discourage physicians from thinking independently and creatively” (5). Groopman has a very good point and that a medical student who has memorized the textbook would not necessarily be guaranteed to excel in a clinical setting. I think a lot of what makes a good doctor is developed outside of the classroom, and requires a certain amount of intuition.
However, Groopman also warns against trusting your gut too much. He tells another story about a disheveled looking man who was brought into the ER after he was found sleeping in public. In this case, the doctor automatically profiled this patient as a drunk bum and wished to send him on his way as soon as possible. When he did examine the man, he found that he was in fact a student and had passed out from extremely high blood sugar.  This story was an example of how following your gut can lead to stereotyping patients and ultimately incorrect diagnoses.
I think it’s very interesting how a doctor’s thought process needs to be creative yet also deeply rooted in medical protocols. Such a concise way of thinking just seems so difficult to achieve and even more difficult to teach. I would be very curious to see how the creative aspect of the medical profession is emphasized in medical schools. 

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