Week 12: Flesh-and Blood Decision-Making

Jerome Groopman

Dr. Peih-ying Lu

May. 13, 2010

According to Groopman, in 1980s, what were interns like? What did they have to do?

How did the first day of intern influence

Dr. Groopman? How has his feeling changed?

In medical school, how do students study paper cases?

Pre-reading questions

How long will it take in a didactic exercise for the senior doctor and students to arrive at a working diagnosis?

How long will it take an expert clinician to form the notion of what is wrong with the patient?

Pre-reading questions

Pre-reading questions According to Dr. Pat Croskerry, what is

pattern recognition?

According to Dr. Donald A. Schön, what is heuristics?

What is the Yerkes-Dodson law? How does it relate to doctors’ performance?

Pre-reading questions

What is the function of the high-tech mannequin named Stan?

Case 1: William Morgan

Case 2: Anne Dodge

• In case 1, Dr. John Burnside spent only 15 seconds finding out what was wrong with Morgan while others spent 15 years figuring out Dodge’s illness in case 2. What’s the difference?

Patterns Recognitions• From the medical history, physical examination,

x-ray studies, or laboratory tests – coalesce into a pattern that the physician identifies as a specific disease or condition. Pattern recognition reflects an immediacy of perception. It occurs within seconds, largely without any conscious analysis; it draws most heavily on the doctor’s visual appraisal of the patient . And it does not occur by a linear, step-by-step combining of cues. The mind acts like a magnet, pulling in the cues from all directions.

Inner Feelings

• Most people assume that medical decision-making is an objective and rational process, free from the intrusion of emotion.

Yet ….

the opposite is true.

In-Class DiscussionWhat are Dr. Groopman’s inner feelings

towards both Anne Dodge’s and Mr. Morgan’s cases?

What do you think the differences and similarities are between these two cases?

Do you think doctors’ medical decisions are made subjectively or objectively? Why?

What is “see one” and “do one”?

In-Class DiscussionIs a fast and frugal medical decision always

better than a nice and slow one? Why or why not?

Do you think the technical errors in medicine, which are like prescribing the wrong dose of a drug, transfusing a unit of blood matched for another person, mislabeling an x-ray of an arm as “right” instead of “left”, are inevitable?

In-Class Discussion

• When are intuition (in The Blink), pattern recognition by Dr. Pat Croskerry, and heuristics by Dr. Donald A. Schön being used?

• How should doctors avoid mistakes when using intuition? Why?

Christine Borland said,

“I’ve tried to speak to young doctors and talked to

them about their real experiences, for example,

of breaking bad news, and how they compare

their experiences as students and whether

they’re drawing on these experiences with actors.

Once they get out there into the real medical

world and they are looking back at their

education, what do they think about it?

However, going by their descriptions, of the

difficulties of breaking bad news, for example, in

a real situation compared with the learning

situation, a lot of them were questioning the use

of simulated patients.” (Lu, 2010: 96)

Lu, P.-y. (2010). Medical communication as art – an interview with Christine Borland. Language and Intercultural Communication. Vol.10, No.1, 90-99.)