Mind to Market

Friday, July 06, 2007

How Doctors Think

Jerome Groopman, M.D. has taken on the arduous task of penetrating the minds of physicians in his latest book How Doctors Think. As I am always interested in knowledge management in the healthcare and life science industries, I was intrigued by the topic and have been reading the book. What is of primary concern to me is: given the vastly increasing amounts of information that physicians must consume and process, how can they best leverage this knowledge to improve patient care? Groopman offers little if any advice in that realm. "Keep an open mind," "listen to your patients," are all good suggestions but how and when does the physician keep up with the latest in advances in the field?

Groopman's driving concern is the accuracy of diagnoses; only by properly diagnosing a disease can it be effectively treated. This is fundamental to the practice of medicine and a principal which everyone in the healthcare industry can agree. Groopman then cites many cases where diseases were improperly diagnosed and why. He points out the differences between medical mistakes; technical errors such as picking the wrong leg to amputate, and misdiagnosis; a result of flawed medical thinking. He cites a study that states that the majority of errors in healthcare delivery were due to misdiagnosis.

Although better information management may reduce technical errors, medical mistakes, Groopman feels that electronic medical records may increase cognitive errors; errors created by flawed thinking. He feels that technology drives a wedge between the doctor and patient and encourages the type of mistakes he's seen in his studies. These errors are a result of an early misdiagnosis or framing which has been allowed to continue without question throughout the patient's case. EMR give an artificial appearance of legitimacy to doctors' notes which may result in propagation of cognitive errors.

Groopman sees this as black and white; EMR are dangerous and should not be used because they commoditize medicine and will result in more misdiagnosis. There is no question that there is a push to control, if not reduce, medical costs. To do that requires improving efficiency, automating and streamlining repetitive tasks is one of the first places where this can be done. Early EMR systems may have reduced a physician's ability to think freely constraining the diagnosis process but as systems evolve, and physicians provide more input, EMR systems will become less of a wedge and more of a bridge between physician and patient.

To alleviate the problem of the physician staring into the computer screen and not looking at the patient, how about a wide screen monitor in the exam room where both the physician and patient can look at the record together? Would this result in longer exams as the patient goes through each and every note? If the interface is well designed the patient should be able to grasp the information quickly. One day this information will be owned and controlled by the patients themselves giving them ample time to view it on their own schedule.

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