How Doctors DON’T Think: Groopman on the Today Show

My physician-guru, Dr. Jerome Groopman, was on the Today Show this morning to highlight some of the excellent points he made in his book, How Doctors Think. (My editorial opinion — it’s a must-read for anyone who is having trouble getting diagnosed correctly.)

But I’m beginning to swerve from my usual train of thought surrounding how most doctors think. Whereas I’ve always taken it to a next step to help patients help themselves — I’m taking a bit of a detour today.

Groopman’s background information about the way doctors arrive at diagnoses must be understood by patients:

  1. Doctors make snap judgments about their patients. For example, a doctor will ascribe any symptom a woman over age 50 has to menopause. Or if a patient is diabetic, the doctor will assume any subsequent health problems are related to diabetes.
  2. Doctors always go with their first impressions — and they form them within the first 18 seconds of seeing the patient — which also means they not only don’t listen to anything the patient says after those first 18 seconds, but also means that they try to fit any additional symptoms the patient might recognized into their first impression.
  3. Doctors are not taught to think in med school. They are taught to answer quickly — which means — they don’t think outside the box, because that takes too long.

So the bottom line is that smart patients will bring doctors up short on all this by asking “what else can it be?” or questioning their doctors about symptoms that don’t seem to fit into a profile for their diagnoses.

And I absolutely agree with that bottom line — I’ve agreed with it many times before.

However — I’m also beginning to think a bit differently about this conundrum, too. Whereas I am all about the patient taking responsibility, and I think all patients should be actively participating in their diagnosing and treatment decisions — at what point do we just say, “Whoa!! Hold on!! That may be how doctors think — but they are thinking wrong!”

Groopman stated that 15 to 20% of all diagnoses are incorrect, and that half those patients are then harmed by that misdiagnosis.

Think about it this way: that means that, on average, if you have been to the doctor 10 times, then YOU WERE MISDIAGNOSED TWICE!

Patients themselves can’t make up for that deficit. In addition to patients taking responsibility for participation, I think we need to throw some of the onus back on doctors, too. We can’t simply accept that they don’t do their jobs correctly, we must begin making them responsible for getting it right.

So whereas I usually provide a bottom line to patients, today I’m going to do that for doctors:

  • Doctors, stop interrupting us.
  • Doctors, begin thinking outside stereotypes and profiles.
  • Doctors, stop trying to fit our symptoms into your own little boxes and start building the right boxes to fit them into.

(OK — I can’t help myself here…..)

And patients — start making doctors do all of the above!

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3 Responses to “How Doctors DON’T Think: Groopman on the Today Show”


  1. 1 Connie October 17, 2007 at 11:24 pm

    A doctor who can say, “I don’t know” is tops in my book. That means s/he is willing to admit they are not God or superhuman. That doctor will probably research for answers and send you to other doctors for second opinions.

    And to those docs who think they can figure a patient out in a few seconds needs to go speed dating not diagnosing. First impressions, especially for patients in a doctor’s office are not reliable at all.

  2. 2 Payne Hertz October 18, 2007 at 2:45 pm

    You are spot on about doctors not thinking. Although doctors are supposed to be scientists, and to adhere to the scientific method, the reality is many of them are prone to stereotyping and making snap judgments, and critical thinking skills are sorely lacking in most physicians.Many doctors are prone to substituting medical folklore, rules of thumb and anecdotal evidence for sound science and good, ethically-grounded medicine, and have a related tendency to make decisions based on what is expedient for themselves, rather than what is in the best interest of the patient, and to simply rationalize the decision to do so afterwards.

    I doubt there is any area where this is more true than with pain management–or rather the lack thereof. If you have chronic pain, and mention that a particular opiate drug works for your pain, or report having adverse reactions to previous drugs, wear sweatpants for comfort at exams, or part your hair down the middle (male) you may find yourself branded a “drug-seeker.”
    , and once this “diagnosis” has been made, you may find it impossible to get your pain properly treated or to convince the doctor that you or your problems are legit. None of these stereotypes are based on science, but doctors apply them every day and you will have little trouble finding medical associations and doctors who promote these pseudoscientific “drug-seeker” criteria that are little more than folklore-based quackery.

    I guess the $60,000 question is how do patients get past the often simplistic, primitive mindset of their doctors.

  3. 3 George R. Clark February 14, 2008 at 9:31 am

    My doctor ran a Cat Scan on my lower body after injecting something to make my arteries stand out. I had severe blockages in my calf areas and numerous ones in my pelvic area. He had me go to the waiting room and from there to an examinibg room. His 1st words there were have you ever had an angiogram on your legs. I was ticked off because He had kept me all day waiting for that test and I replied, “No, and I don’t eant any more angiograms because I’ve already had too many of those.” His 1st words should have been why I needed to have another angiogram and explain possible consequences of not having one with stents implanted. What followed seemed to me that after 23 years of my cardiologist treating me I was being dismissed.


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