This is the first in a series of blogs about a personal passion of mine: improving the dialogue between patients and doctors. In each of these blogs, I’ll also explore lessons that can be applied outside medicine – in business meetings.
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When reading about modern day medicine it’s sometimes hard not to think of doctors as super humans. In the most pressurized environment, they manage to solve complex diagnostic puzzles and take on-the-spot decisions while the stakes couldn’t be higher.
The reality is that they’re prone to making cognitive errors - just like any of us. That particularly applies to doctors who are short on sleep, stressed out because of their relentless schedule and under pressure from insurance companies to see more patients in less time.
In “How Doctors Think”, which was originally published in 2007, Jerome Groopman describes the most common fallacies among physicians and how patients and their loved ones can and should play a role in addressing those to improve medical decision-making:
“Doctors desperately need patients and their families and friends to help them think. Without their help, physicians are denied key clues to what is really wrong.”
Asking Critical Questions
Dr. Groopman knows what he’s talking about. He’s a Professor of Medicine at Harvard Medical School and has been practicing as a physician for over four decades. For his book, he researched numerous cases and interviewed medical professionals – from pediatricians to surgeons and radiologists – about how they think and interact with patients. One of his key findings:
“Technical errors account for only a small fraction of our incorrect diagnoses and treatments. Most errors are mistakes in thinking. And part of what causes these cognitive errors is our inner feelings, feelings we do not readily admit to and often don’t recognize.”
In other words, doctors need their patients to help them think. Here are a few of the cognitive pitfalls that are highlighted in the book and suggestions for how patients can help avoid those:
Availability heuristic. Judging the likelihood of an event by the ease with which relevant examples come to mind. If a doctor has seen a number of pneumonia cases over the past few weeks, it doesn’t mean that the patient in front of him has the same sort of infection. Patients can ask: what’s the worst thing this can be? Dr. Groopman: “By asking that question, a patient, friend or family member can slow down the doctor’s pace and help him think more broadly. You can prompt him to consider lifting his anchor from the most available harbor.”
Search satisfaction. The tendency to stop searching for a diagnosis once you find something. Patients can ask if there are alternative explanations (“What else can it be?”) and whether it’s possible that they have more than one problem, which should ”trigger the doctor to cast a wider net”.
Attribution error. Fitting a patient into a negative stereotype based on personal prejudice or bias. Patients should articulate that they understand that they fit a certain stereotype but that their complaints should not be ignored. Dr. Groopman describes a case in which a patient tells her doctor: “Okay, I know menopausal women have hot flashes. But I think this is something else.” After this, the doctor stopped herself from casting the patient as a stereotype, did more tests and found a tumor that could be removed.
Confirmation bias. In the words of Dr. Groopman, each of the fallacies mentioned above can set off “a cascade of cognitive pitfalls”, which could result in premature closure of the diagnostic process and misguided care. This process is exacerbated by confirmation bias, or tunnel vision: the tendency to confirm what you expect to find by selectively accepting or ignoring information.
Connecting the Worlds of Business and Medicine
I’m intrigued with Dr. Groopman’s approach, which can also be applied to business conversations. If you understand which cognitive errors are prevalent in your line of work, you can be much more effective in challenging team members on their decisions and recommendations.
In journalism, for instance, confirmation bias can lead to unbalanced and unfair coverage. As an antidote, editors should ask journalists how they know what they know and what reporting they have done to show the other side of the story. This should prompt reporters to take another look at their sources and imagine if the opposite story could also be true.
Investors could also follow this path. When meeting with a CEO to build an investment case, consider asking questions to expose some of the most common thinking flaws in the boardroom such as the availability heuristic (“What other options have you considered?”)
Unfortunately, most of us will have serious conversations with doctors at some point in our lives - for ourselves or our loved ones. Whether it concerns your health or business, the awareness of cognitive pitfalls will enhance the dialogue and will inevitably result in improved decision-making.