Thursday, May 17, 2007

How Doctors/Christian Workers Think

This week I’ve been reading How Doctors Think by Jerome Groopman, MD. Perhaps someone reading this post might want to write a book about How Christian Workers Think. I doubt it could make much money though! Please feel free to share your applications and comments related to the following tendencies as to how doctors think in relation to us as Christian workers:

1. The sickest patients can be the least liked by doctors:
Very sick people can even sense the disaffection that comes from their doctors… Physicians can be prone to a visceral sense of disgust when working with certain patients, especially those who do not appear to be taking care of themselves (e.g. alcoholics with cirrhosis or heavy smokers with end-stage emphysema, p. 45).

Doctors like healthier people more is because they have deep feelings of failure when dealing with diseases that resist even the best therapy; in such cases they become frustrated, because all their hard work seems like it’s for nothing. So they tend to want to put those who fall into that category out-of-sight and out-of-mind.

2.Doctors frame data selectively:
Medical students have in the back of their minds the goal of storing an encyclopedia in their minds, so that when they meet a patient they can open up a mental book and find the correct diagnosis and treatment right away. (p. 28) The instruction of clinical reasoning is such that medical students are taught to follow algorithms and practical guidelines.

As they gain experience, however, physicians tend to go with their first impressions. The initial biases in a physicians’ thinking are often reinforced by his selective survey of diagnostic data (p. 262). If these first impressions are dead-wrong, and other physicians follow them, then for patients with long histories there will be “cascades of cognitive errors.”

Most doctors quickly come up with two or three possible diagnoses from the outset of meeting a patient… They develop their hypothesis from a very incomplete body of information,” framing data very quickly, using shortcuts called heuristics. (p. 35) (For another interesting book that discusses how we thin-slice data in making quick judgments and how to improve in our decision-making ability, read the book Blink Here’s the amazon link or, like me, you can check it out at your public library!)

3. Doctors fall into cognitive traps:
Most of the time, doctors misdiagnose because they fall into cognitive traps, not because they have inadequate medical knowledge. “A growing body of research shows that technical errors account for only a small fraction of our incorrect diagnoses and treatments. Most errors are mistakes in thinking. (p. 40)

4. Emotions blur a doctor’s ability to listen and think:
And part of what causes these cognitive errors is our inner feelings, feelings we do not readily admit to and often don’t even recognize. (p. 40)

Medical decision-making is not an objective and rational process. The physician’s internal state, his state of tension, enters into and strongly influences his clinical judgments and actions. 36

For example, physicians who dislike their patients regularly cut them off during the recitation of symptoms and fix on a convenient diagnosis and treatment. “The doctor becomes increasingly convinced of the truth of his misjudgment developing a psychological commitment to it. He quickly becomes wedded (I think a better word might be welded!) to his distorted conclusion. His strong negative feelings about the patient make it harder for him to abandon that conclusion and reframe the clinical picture differently.” (Page 25)

Likewise, diagnoses are missed when physicians are overly attracted to their patients in positive ways. When a physician likes his patient, overly sympathizing with his or her pain, he or she can unconsciously hold back on certain tests or treatments which will cause the patient added suffering.

5. Good doctors learn from their mistakes:
A certain cardiologist kept a log of all the mistakes he knew he had made over the decades, and from time to time revisited this compendium when trying to figure out a particularly difficult case. “He was characterized by many of his colleagues as eccentric, an obsessive oddball. Only later did the author realize his implicit message to physicians was to admit our mistakes to ourselves, then analyze them, and keep them accessible at all times if we wanted to be stellar clinicians.” (p. 21)

Food for Thought for Christian Workers:
1. What factors out there predispose us to gravitate more to certain kinds of people? To what degree are we governed by “fear of failure” in how we approach our various missiological enterprises? Who are the people on our fields whom we more easily categorize as“out-of-sight out-of-mind”? How can we be more like our Great Physician in this regard?
2. How can we learn to more effectively and accurately "thin-slice"? What improper diagnoses do we tend to make early on with regard to the spiritual conditions of certain people?
3. Are we able to see past our emotions and preconceptions in decision-making, proactively engaging situations around us, etc? How do we go too far or not far enough in interacting with certain people because we like them or do not like them?
4. What cognitive traps are we prone to fall into that plague us for years down the road missiologically? How open are we to redirection?
5. Without dwelling too much on our pasts, are we reflecting upon our mistakes often enough?

1 comment:

hanching chung said...

I like to thank your blog.

I am checking a recent Taiwanese translation of this book to visit your blog.

By the way, I used your blog as an example of English prattler.

Thanks again.