Groopman is obsessed with heuristics, the often unconscious and particularly human strategies of pattern recognition that doctors use to make quick decisions. In an effort to eliminate these errors, he writes, medical schools have begun training students to abandon heuristics in favor of a purely systematic, stats-based approach—airtight algorithms, templates, prototypes, and “decision trees” that will guide them, step by rigid step, through every conceivable interaction with a patient, like an IT technician with his list of questions. (“Does your spleen hurt?” “Yes.” “Is it burning or pounding?”) Groopman, a humanist all the way down to the roots of his white beard, sets himself against this trend. “The next generation of doctors,” he writes, is “being conditioned to function like a well-programmed computer that operates within a strict binary framework.” Diagnosis via checklist, he argues, leaves little room for independent creative thought; eliminating the risk of human error also eliminates the possibility of real human achievement. (It’s like the sabermetrics debate in baseball, transposed to the hospital.) Groopman sees language—the patient’s story—as the essential foundation of the doctor-patient relationship, and he stresses that doctors will always think like humans: They’ll feel the urge to assume, overlook gaps in their knowledge, and massage partial information into a recognizable whole. The trick, as he sees it, is to be even more human, more self-conscious about moods and prejudices and cognitive processes. In the face of familiar depersonalizing trends in medicine—pressure from pharmaceutical companies to think less and prescribe more, doctors’ falling incomes producing a higher volume of patients—Groopman’s advice seems commonsensical and wise. Doctors should ask open-ended questions, stop interrupting, and embrace uncertainty rather than leaping ahead into a scripted false confidence.
Groopman also has advice for patients. Instead of being terrified and intimidated, we should say things like, “I sense that we may not be communicating well” and “Is there anything that doesn’t fit your diagnosis?” and “Is it possible I have more than one problem?” While I can no more imagine myself saying any of these things to an actual doctor than I can imagine slapping a mountain lion in the face with a piece of raw chicken, thanks to Groopman I can begin to see the wisdom of trying. n
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