I just finished Jerome Groopman’s How Doctors Think. In general, I think the topic of medical thinking is fascinating. I was a little disappointed by the book, which is long on colorful anecdotes and personal experiences but short on research and policy. I’m difficult to please.
One frustration I had with the book is that Groopman had sprinkled paragraphs throughout the book that say something like, “To avoid a medical thinking mishap like the one this anecdote illustrated, you might consider asking your doctor X.” Because there was no appendix collecting these questions, I’ve put those questions and their motivations here.
Before a diagnosis
I’m really worried that these symptoms mean X. Is that possible? [The idea here is to get you to say the thing that’s really worrying you, even if you fear that naming it will make it real.]
What is the worse thing this could be? Is there a possibility that these symptoms are related to something that could kill or seriously injure me? [The idea here is to encourage the doctor to think outside the box of normal, routine illnesses.]
What body parts are near where I am having this symptom? [The idea here is to encourage the doctor to enumerate other possibilities for where the symptom is coming from. The gut is near the ovaries, and a bad stomach ache might actually be an ectopic pregnancy.]
After a diagnosis
What else could this be? [It’s tempting to stop searching for things once you’ve found one thing. This encourages the doctor to think that maybe there is something more that she should look for.]
What if I have more than one problem? [_Again, it’s tempting to diagnose a single condition. One condition might hide another__._]
Which of my signs and symptoms don’t fit this diagnosis? [Asking for contradictory evidence can fight confirmation bias.]
Let me tell you my whole story again. Try to forget what you heard the first time and the diagnosis you made. [This is hard to do for the same doctor, but it might help if you go to another doctor. It’s easy for a doctor to read another doctor’s diagnosis, accept it as fact, and not think on their own about the raw data of your experiences.]
Before assenting to a test, scan, or procedure
What’s the probability that something will be found? [This fights a kitchen sink or “let’s see what we see” kind of thinking.]
What can this test uncover that will confirm or change my diagnosis? [It’s tempting to just order a test without having a clear sense of whether that test is actually the right thing to do for that diagnosis.]
How often does this test give wrong results? [To not allow the doctor to unload the cognitive burden of figuring out what is wrong.]
When can the data from this test give the wrong impression? [To encourage other ways of thinking or testing that can be correlated against an imperfect test.]
What are possible complications?
If there will be pain or discomfort, what other experience I’ve had has had a comparable amount of pain? A mosquito bite? A migraine? A bone being set?