The trouble with Dr. Jerome Groopman’s book, How Doctors Think, is that the docs who really need it won’t read it.  But patients will, thanks to word-of-mouth buzz since it was published in 2007.

As a patient who has experienced a life-threatening misdiagnosis while having a heart attack, my own favourite part of the book is Dr. Groopman’s review of physicians who take “cognitive shortcuts’ during patient visits.

This means that doctors can jump to conclusions about diagnosis or treatment options, and then can’t budge even when contradictory evidence subsequently emerges. “Blame the 18 Second Rule!” advises Dr. Groopman, professor of medicine at Harvard. ”That’s the average time it takes a doctor to interrupt you as you’re describing your symptoms. By that point, he/she has in mind what the answer is, and that answer is probably right about 80% of the time.”

You may be saying by now: “Well, Carolyn, being right 80% of the time sounds like a pretty darned good track record, even if the doctor has jumped to conclusions and interrupted me after just 18 seconds!”  This may be true, unless of course you happen to be one of the poor misdiagnosed schmucks in that 20% group. “It’s not that  doctors lack sufficient clinical knowledge, but are rather tripped up by their biases,” writes Dr. Groopman.

Here’s how things can escalate once inaccurate bias comes into play. “Doctors are stumped by symptoms all the time,” explains Dr. Groopman, “By prescribing the wrong medication, for example, they often worsen the problem or even create a new one. Worse, misdiagnoses lead to an astounding 40,000-80,000 hospital deaths every year according to the American Medical Association, plus an uncounted number due to mistakes in the doctor’s office. Some 5% of autopsies find a condition missed by doctors that, if treated, might have saved the patient’s life.” Alarmingly, he describes the reality, actually researched at Johns Hopkins, that when doctors develop a dislike of a particular patient, they tend to shut down and close their minds. “It’s a set up for misdiagnosis - you do not get good care.”  (more…)