Last winter, in a time period of just a few days, three or four people told me I had to read this book called “How Doctors Think.” It is written by a doctor about the process of decision making in medicine, which has a lot of faults driven by doctor’s personalities, their training, and a system that encourages seeing lots of patients in as little time as possible.
I finally got this book from the library last weekend, and I read about half of it yesterday. The stories in the book totally resonate with me, as they tell of doctors who missed diagnoses and made bad decisions for any variety of reasons. (If you like the show “House” and/or the documentary show “Mystery Diagnosis”, you would probably love this book!) The doctor writes about doctors who don’t listen to their patients, who make decisions based on test results alone, who diagnose problems that “pretty much” fit instead of looking for the diagnosis that fully fits the patient’s symptoms. The doctor writes about his own errors in thinking about cases, for example, when he felt bad for a patient and didn’t want him to go through a more extensive set of tests or physical exam because he’d already been through so much — and he thereby missed a major problem with the patient.
I read this book and nod, remembering the many doctors who made these errors in thinking with my case. I remember doctors who decided before they even spoke to me that they knew what was wrong with me or, worse yet, that nothing was wrong with me even when I’m sitting before them overflowing with symptoms. I remember doctors letting me tell about 30 seconds of my story before they cut me off. I remember doctors acting like I was either neurotic or a total pain because I asked questions — how dare I actually want to understand what’s going on, why they are ordering certain tests, what they are looking for, and what I can do to help myself!
Fortunately, because I know I’m a rare case in every sense of the word and because we’ve always gotten to the bottom of every persistent problem I’ve had, I know better than to just accept a decision or judgment that a doctor has made when it seems off to me. I sometimes want to say so badly, “Thanks for your opinion, but you’re wrong!” But any doctor who didn’t listen to me and didn’t try to work with me on figuring out what’s up, would also probably be a doctor who would get irate when I said that! And I’m not on this planet to make people mad, but I also don’t have to involve them in my care or let them guide my treatment either. I know there are better doctors out there. I have seen a bunch of them! Instead of cutting me off when I tell my story, they ask good questions and want to fill in any gaps I leave in the story. They let me in on what they are thinking and how we might proceed, giving me options and telling me about outcomes with other patients but also realizing I’m my own case and might respond better, worse, or just differently than other patients. The four specialists who are actively involved in my case at this time are good listeners and good thinkers. I really wouldn’t have it any other way.