Pattern Thinking

I recently read a book entitled "How Doctors Think" (I recommend this book if you are interested, it was written for laymen too). I took away some great understandings from the book, especially the fact I don't think I could be a physician!

One aspect of being a good doctor who treats patients is a real conundrum; that is - to be a good doctor you not only have to care for the patient, you have to care for the patient. I thought this was a great line and wraps up a lot of the human interactions doctors have to bear. The book also helped me realized that doctors are real people too; with real emotions, flaws, biases, tendencies, and the same quirks we all have. Their challenge is to overcome these patient by patient in order to get a good diagnosis and to provide great ongoing care.

One, out of many, thinking flaws a doctor much watch out for, for example, is "pattern thinking". This is best described by putting yourself in the shoes of a doctor, say a G.P., who is seeing many patients on a daily routine. Insurance nowadays is requiring these doctors to see more patients so they average around 15 minutes per patient. Suppose there is a usual cold or flu virus in the community and lots of patients are coming in with the same symptoms. What if a patient comes in with 9 out of 10 of the same symptoms? The tendency would be to diagnose that patient with the same flu.

However, that one symptom, whether it be overlooked or missed altogether may be the symptom that totally segregates that patient from the others and may indicate something like pneumonia. And, if this patient had another condition already and was more at risk than most healthy patients, say diabetes, then the doctor, by overlooking that one symptom could put that patient's life at risk. In the rush to complete rounds or hit quotas, it is so easy to evaluate a patient less thoroughly and make quick decisions. In fact, most doctors make a stab at a diagnosis within seconds of seeing a patient, before the patient ever presents the symptoms!

This "pattern thinking" doctors must guard against really had an impact on me, because I do it too! I thought, if I do it, I bet others must do it. We see this in its most insidious form in racism and personal biases - ascribing characteristics to groups of people. We also see it in our day to day decisions about work....how many times has someone said, or thought, "I've seen this a million times"? That is exactly pattern thinking and can miss the smallest little piece of information that may totally change the diagnosis and/or the best decision possible for the situation.

We often talk about "thinking outside the box", which also goes hand in hand with pattern thinking. This means, trying to think differently about a situation, think creatively. So it seems that if we both avoid pattern thinking and think creatively, then we have a new powerful way to view the world and the situations we face. As humans, we tend to use such a small part of our brain and I would suggest pattern thinking is one way to use less. Thinking outside the box and avoiding pattern thinking are ways to use more.

Next time you face a situation that you have dealt with many times and it involves complexity, stop to ask the questions: do you have all of the information you need for a sound decision? Is it a fair decision to all involved? Is there another outcome possible? Have you asked all of the questions you could have of your "patient"? If you do this regularly for a while, I bet you will come across several instances of a situation that will change your mind about your normal decisions and you (and probably someone else involved) will come up with a better solution. Try it and see. Better yet, read the book! "How Doctors Think" by Dr. Jerome Groopman.

posted by Scott Messmore @ Tuesday, August 07, 2007   0 comments