Thursday, March 22, 2007

Doctorly links

First, Dr. Jerome Groopman on the kinds of mistakes (and logical fallacies) in diagnosis doctors make.

Let's deconstruct Leslie's case. Yes, the arrival of a third child can cause stress in a family. This truth strongly colored the physicians' impressions, so they made what is called "an attribution error." This involves stereotyping -- in Leslie's case , casting her as an anxious and somewhat depressed and distraught postpartum woman. The diagnosis of indigestion and abdominal discomfort with occasional diarrhea was too quickly fit into the pattern of a stress-related condition.

The doctors fixed on this diagnosis, so called "anchoring" where the mind attaches firmly to one possibility. Anchoring so tightly to one diagnosis and not broadly considering others is called "premature closure." Even when, later in Leslie's evaluation, a blood test result was obtained that was very abnormal, it was not sufficiently considered; no one involved in her case could lift their mental anchor and comprehensively explore other possibilities.

Discounting such discrepant or contradictory data is called "confirmation bias" -- the mind cherry-picks the available information to confirm the anchored assumption rather than revising the working diagnosis.

We have met Dr. Groopman here.

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And, this one is for my ophthalmologist wife: NYTimes carries a wonderful article by Jane Brody about the advances in cataract surgery that has made it a two-hour outpatient procedure.

After a preoperative health checkup and eye exam by the ophthalmologic surgeon, he entered a freestanding eye clinic at 8 one morning and walked out an hour and a half later with a “new” eye, able to walk the streets, drive and even read without glasses. The morning after surgery, the acuity in his left eye was already 20/25, and further improvement was expected as it healed.

It is nothing short of amazing. ...


  1. ggop said...

    Thanks! I bought Groopman's "How Doctors Think" book yesterday.
    Looking forward to reading it.