HOW DOCTORS THINK
  Karl Arnold Belser
13 February 2016



My square dance club, the Rockin' Jokers, just initiated a book club. I joined because I am interested in classic fiction that has proved the test of time like Les Miserables, and books relating to behavioral economics. The first book the club is reading was How Doctors Think by Jerome Groopman. This book is clearly in the later category because it promises to discuss "decisions of individuals and institutions and the consequences for market prices, returns, and the resource allocation."

This book gives anecdotes about several situations in medicine in which doctors had difficulty making the “correct” decision. The question is: What can the patient do to help the doctor in making better decisions?”

Groopman implies that mistakes by doctors are frequent and that the patient should be somewhat afraid and skeptical. I think that this might motivate people. However, it is statistically incorrect. I note that if the doctor is almost always correct this knowledge might lull the patient into a blind trust and de-motivate him from being skeptical.

For me, the main point of the book is that I should be constantly skeptical. I learned that I should question every treatment by asking questions.

       Is it possible that there is another disease the looks like this one?
  
       What are the side effects of the treatment you recommend?

       What are the probabilities of the side effects happening?

Also see the AARP article Why Doctors Make Mistakes by Goopman for more suggested questions.

I thought that the book was well worth reading for the lay person to encourage them to be more proactive in treating any medical issue.

Now I want to give a negative critique because Groopman misses probably the most important issues in medicine today – the occurrences of false positives and the probabilities of unwanted side effects. A false positive is when a visual observation by the doctor or a specific test indicates that a person has a disease when the person doesn't actually have it. The existence of very bad side effects of a drug or medical procedure when a person is perfectly healthy is the case in point.

I wrote my doctoral dissertation on statistical decision theory and I find it unusual that an educated person would not discuss base rate probabilities, false positives or Bays theorem. It takes lots and lots of experiments to determine probabilities. this is essentially the scientific method. Making a medical decision on anecdotal evidence is probably the least reliable way to practice medicine. See my post  False Positive Probabilities.

I will leave my comments at these because I think the book is a good start in encouraging people to be skeptical.

    
Last updated February 15, 2016
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