Dr. Jerome Groopman’s recent book, How Doctors Think, applies not only to diagnosis and treatment but also to physicians’ ability to work more interdependently.  He wrote that people can be true partners with physicians when they know how physicians think and what thinking errors they make.

Dr. Groopman feels that three types of thinking errors interfere with physicians’ ability to make correct assessments:

• Anchoring: making snap judgments, seizing on only one aspect of a problem and not considering multiple possibilities; a question that can help physicians avoid this error is, “What else might your findings be due to?”
• Attribution: sterotyping others’ responses, so that one does not need to take them seriously; one antidote to this process is to send up a red flag whenever one feels strong emotions clouding one’s thinking patterns (perhaps easier said than done, since we all have blind spots); another way is to surround ourselves with people who can alert us to our blind spots, provided that we listen (rather than attack them)
• Availability: making judgments based on recent examples that come to mind that may reflect distorted pattern recognition; an antidote is to ask systematically, “Are there any data points at odds with the conclusion?”

Dr. Groopman quoted Dr. Lee Goldman, Vice-President for Health Affairs at Columbia College of Physicians and Surgeons, who said, “One lesson… is to remain humble and open to changes in our thinking,” (p. 292). As one of my surgical mentors advised, “Whenever you think that you know more about a subject than anyone else, it’s time to retire before you hurt people.”

I am asked frequently, “How do you engage physicians who don’t want to be engaged?” A practicing physician  (with a reputation for being a curmudgeon) advised:

“If they do not want to have anything to do with you, ask them why not!!…..that is a definable set of reasons and (mis) perceptions you might have to dig out of them, realizing that you might not like and may not want to hear what they say, but once understood gives you something to work with.
To me it is all about building trust and identifying areas of passion for them, and areas where you can improve their lives (processes) or their incomes (JV’s etc)….you have to come up with something of interest to them…what can you do for them, not what they can do for you.”

What do you think?

• Have you ever called a physician on his/ her thinking
• Have you asked physicians who were avoiding you why they were taking that course of action
• What did you learn from their replies

 As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn