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'An aphorism, properly stamped and molded, has not been "deciphered" when it has simply been read; rather one has then to begin its interpretation, for which is required an art of interpretation.' -- Nietzsche, 'On the Genealogy of Morals'

medicine: flawed thinking « Previous | |Next »
May 27, 2007

Richard Horton's What's Wrong with Doctors in the New York Review of Books is a review of Jerome Groopman's How Doctors Think. It is a critique of medicine's mistaken direction. The argument is that doctors must learn to think differently.

A solid base of medical knowledge is not enough to be a good physician or surgeon. Research into cognitive errors in medicine reveals that most mistakes are not technical. They stem from mistakes in thinking. Intuition, a clinical sixth sense, for example, is unreliable. But equally, the assumption that medicine is a totally rational process is also wrong. Doctors may be reasonably smart, but they repeatedly fall into common and well-defined traps.

What are the traps? It's the way they think in terms of its discourse.

Groopman says:

I like to conduct rounds in a traditional way. One member of the team first presents the salient aspects of the case and then we move as a group to the bedside, where we talk to the patient and examine him. The team then returns to the conference room to discuss the problem. I follow a Socratic method in the discussion, encouraging the students and residents to challenge each other, and challenge me, with their ideas. But at the end of rounds on that September morning I found myself feeling disturbed. I was concerned about the lack of give-and-take among the trainees, but even more I was disappointed with myself as their teacher. I concluded that these very bright and very affable medical students, interns, and residents all too often failed to question cogently or listen carefully or observe keenly. They were not thinking deeply about their patients' problems. Something was profoundly wrong with the way they were learning to solve clinical puzzles and care for people.

He identifies that the flaw in his thinking is different from the the new generation:
My generation was never explicitly taught how to think as clinicians. We learned medicine catch-as-catch-can. Trainees observed senior physicians the way apprentices observed master craftsmen in a medieval guild, and somehow the novices were supposed to assimilate their elders' approach to diagnosis and treatment. Rarely did an attending physician actually explain the mental steps that led him to his decisions. Over the past few years, there has been a sharp reaction against this catch-as-catch-can approach. To establish a more organized structure, medical students and residents are being taught to follow preset algorithms and practice guidelines in the form of decision trees.

| Posted by Gary Sauer-Thompson at 11:24 PM | | Comments (1)
Comments

Comments

Gary, There are dozens of books available which point out out the limitations of the dominant allopathic sickness paradigm and its reliance on drugs and surgery.

One of my favourites is titled Radical Healing by Rudolph Ballentine who was trained as an MD and became completely dis-illusioned with the glaring reductionist lmitations of the standard allopathic model of health and sickness---so he did what a true scientist does and engaged in further study (and applied practice)under some highly accomplished non mainstream and non western healers. The results are published in his remarkable book---the Guide to Further Study section at the back of the book is an education in itself. The book is "illustrated" with some remarkable case studies of seemingly impossible healings etc.

See: www.radicalhealing.com