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Why doctors (and other experts) make so many mistakes: the feedback problem.

I've bought some fantastic books from a clearance sale in Victoria University today. These include How Doctors Think by Jerome Groopman (2007).

I've not read the book yet, just skimmed through the initial sections, but this is one book that I suggest you buy and read carefully.

It could well save your life.

Regular readers of my blog will know that I've vigorously argued against the modern cult of the "expert". In particular, I've shown how MOST doctors and economists are incompetent (and most psychiatrists are not just incompetent, but are positively dangerous!). Such strong views – although FULLY supported by facts – have not been found pleasing by some readers who love to worship those who have degrees.

But note that such incompetence is almost never a result of deliberate malice. It is just the nature of reality that human knowledge is limited, that we often forget what we learnt, and that what we think is often biased. In other words, we are human. And humans are imperfect, and make mistakes.

Groopman cites a paper by A.S.Elstein, published in 1995 ["Clinical reasonining in medicine"] which showed that 15 per cent of diagnoses are INCORRECT. In my view, though (from personal experience of meeting doctors over the past 30 years), the true rate of error (for complex cases) is close to 95 per cent. In other words, doctors get the diagnosis wrong in 15 per cent to 95 per cent of the cases.

The main reason why this continues to happen is because doctors (and economists) don't usually get feedback. The patient who is diagnosed wrongly simply never comes back, and goes to another doctor. So the doctor thinks he has cured the patient, but the patient was not cured, and will never return. And when a patient DOES provide feedback (as I've provided to one of my eye doctors), the doctor is so stunned that he doesn't learn.

The key message of Groopman's book is that you should ask questions.

I'd like to add that you should conduct your own research. (e.g. among the books I've bought today is a medical school textbook on physiology and a fully illustrated book on clinical nursing. Knowledge and critical thinking are both crucial.)

As a first step MAKE A LIST OF ALL POSSIBLE DIAGNOSES. Use your doctor as an INSTRUMENT, a tool, of your analysis.

Remember you are paying for the doctor's time. Ensure that you get full value. Confirm that the doctor has considered all possible diagnoses and check why he thinks some of these are not relevant. Doctors tend to rush to judgement. Slow down your doctor's rush! If he doesn't like being slowed down, leave and never return.

And always consult multiple doctors. And google.

And use your own head.



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