The New York Review of Books

Reviews by Jerome Groopman, M.D.

Carrying the Heart: Exploring the Worlds Within Us

by F. González-Crussi

Kaplan, 291 pp., $26.95

The Deadly Dinner Party and Other Medical Detective Stories

by Jonathan A. Edlow, M.D.

Yale University Press, 245 pp., $27.50

“Several months ago, I led a clinical conference for interns and residents at the Massachusetts General Hospital. It was thirty-three years since I had trained there, and beyond discussing the topic of the gathering, I was keen to learn from these young doctors how they viewed recent changes in the culture of medicine.

“The subject of the conference centered on how physicians arrive at a diagnosis and recommend a treatment—questions that are central in the two books under review. We began by discussing not clinical successes but failures. Some 10 to 15 percent of all patients either suffer from a delay in making the correct diagnosis or die before the correct diagnosis is made. Misdiagnosis, it turns out, is rarely related to the doctor being misled by technical errors, like a laboratory worker mixing up a blood sample and reporting a result on the wrong patient; rather, the failure to diagnose reflects the unsuspected errors made while trying to understand a patient’s condition. ^{(Emphasis added)}

“These cognitive pitfalls are part of human thinking, biases that cloud logic when we make judgments under conditions of uncertainty and time pressure. Indeed, the cognitive errors common in clinical medicine were initially elucidated by the psychologists Amos Tversky and Daniel Kahneman in their seminal work in the early 1970s. At the conference, I reviewed with the residents three principal biases these researchers studied: “anchoring,” where a person overvalues the first data he encounters and so is skewed in his thinking; “availability,” where recent or dramatic cases quickly come to mind and color judgment about the situation at hand; and “attribution,” where stereotypes can prejudice thinking so conclusions arise not from data but from such preconceptions….” (Emphasis added)

Source: The New York Review of Books, November 5, 2009