Marginal Revolution: How Doctors Think

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How Doctors Think

...the sickest patients are the least liked by doctors, and...very sick people sense this disaffection. Overall, doctors tend to like healthier people more.

That is from Jerome Groopman's new and excellent How Doctors Think. The book claims that by asking your doctor better questions, you can help him or her overcome cognitive and emotional biases. For instance doctors too frequently assume that the recent cases they have seen constitute a real trend, or they too quickly assume that what they see fits a known medical pattern. Here is one story on the book. Here are Groopman's New Yorker articles. Here is Groopman summarizing the book in The New Yorker.

Posted by Tyler Cowen on March 21, 2007 at 01:04 PM in Medicine | Permalink

Comments

Quoted: "...the sickest patients are the least liked by doctors, and...very sick people sense this disaffection. Overall, doctors tend to like healthier people more."

Speaking as a non-practicing MD, who has written a book on medical education, I should say that truth is pretty much the opposite to the above statement. Doctors like dealing with sick people more than healthy ones. Which is just as well...

Posted by: Bruce G Charlton at Mar 21, 2007 3:20:29 PM

One suggestion I've found helpful is that if you have the insurance to pay for it (e.g., two sources of insurance), have two regular doctors. Make one the best diagnostician you can find. Make the other a loser who is scraping by financially and will therefore agree to authorize whatever you want because he doesn't want to lose you as a patient. Use the good doctor when you can't figure out what's wrong with you, and use the bad doctor when you can and just need a prescription to fix it.

Posted by: Steve Sailer at Mar 21, 2007 4:42:56 PM

Here's another suggestion, based on my experience with cancer in 1997. In Chicago, there were three Non-Hodgkins Lymphoma experts, each of whom wanted to recruit me for his clinical trial of an experimental drug. Which one should I trust with my life? A rather difficult decision, especially since A) I didn't know anything about cancer and B) I was carrying around a bottle of Xanax to stave off panic attacks.

As a corporate executive, whenever given an assignment to, say, choose a new accounting software system for my company for which there were three vendors, the natural reaction would be to hire a consultant to help me choose. I had never heard of anybody doing that as a patient, but, with my life on the life, I didn't intend to stand on tradition.

So, I hired a fourth doctor, a young general oncologist, to be my consultant in choosing among the three lymphoma specialists. "Medical ethics" (an oxymoron?) prevented him from interviewing the specialists himself, but I would report back to him after each meeting. Together, we decided to go with the trial that was testing the old semi-reliable chemotherapy plus a new monoclonal antibody (which is now the billion dollar Rituxan drug).

And, a decade later, I'm here to tell you about it (knock on wood), so it appears to have been the right approach.

Of course, I was very lucky to have the kind of old-fashioned medical insurance that would pay for such a system.

Posted by: Steve Sailer at Mar 21, 2007 4:55:06 PM

And that's what genetic superiority will do for you!

Posted by: Chris M. at Mar 21, 2007 4:59:38 PM

Steve Sailer's story is worth pondering wrt health care reform.

It is often said that a paternalistic health care system is inevitable - in which decisions concerning treatment are made by providers (eg doctors) or payers (insurance companies or the government). And it is said that this is inevitable because of information assymetry - the patient doesn't know enough to evaluate health care.

Steve demonstrates one way that the market can reduce information assymetry - by clients employing expert agents to work in their own interest. We can pay a mechanic to look over a second hand car before we buy it, or a surveyor to look over a house - Steve employed one doctor to look over another.

Indeed, medical agents can be institutionalized as general practitioners or family physicians who provide cheap health care and act as agents for their patients when it comes to making decisions about expensive health care.

Posted by: Bruce G Charlton at Mar 22, 2007 1:58:16 AM

Groopman was recently on Fresh Air talking about this book:
http://www.npr.org/templates/story/story.php?storyId=8892053&ft=1&f=13

Posted by: PRT at Mar 22, 2007 12:38:02 PM

i dont really agree with the thought that doctors like healthy poeple more. everytime ive been really
sick and seen a doctor, ive always gotten the same treatment and compassion. I think what the real
problem is is where the person is going to be seen. If its a good Dr. it shouldnt matter, they still get
paid either way.

Posted by: james at Mar 26, 2007 9:44:48 PM

I have to say that the statement about doctors favoring healthier people, in my opinion, is far from the truth. Doctors go to school to treat the sick and learn exactly how to care for any and all patients that walk through their door. If they can't help them they will refer them to a doctor who can. If there weren't any sick patients then how would doctors get paid? I do however believe that doctors don't ever want to wish illness on anyone, but they are happy to be the ones taking care of their patients.
I also have to comment that doctors are health care providers. They were given the "gift" to serve and help individuals no matter how sick they may be. I believe that doctors who enjoy their job are not described in the above statement.

Posted by: Meagan H at Mar 26, 2007 10:56:41 PM

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