Avoiding Medical Mistakes

According to Dr. Jerome Groopman, author of How Doctors Think, most medical mistakes are not related to technical errors or miswritten or misinterpreted prescriptions. Rather, Dr. Groopman argues that more than 80 percent of misdiagnoses are the results of cognitive errors on the part of doctors.

To understand how and why doctors succumb to detours in judgment, Dr. Groopman says he looked at how they think and the ways they often get sidetracked from the truth by using decision-making techniques that all of us use on a daily basis. Dr. Oz talks to Dr. Groopman about ways that doctors can avoid making mistakes in the medical practice, as well as ways that patients can get involved and help their doctors make the right decisions.

Ways doctors can avoid making mistakes:

• Truly listen to a patient's full story. Dr. Groopman tells the story of a young woman who was diagnosed with anorexia because she suffered from indigestion and vomited after eating. Finally, after seeing more than 30 doctors and specialists, the woman was properly diagnosed with celiac disease—an allergy to gluten, one of the main components of wheat and other grains. "By really thinking differently and not just following the momentum of her diagnosis, and not being stuck to the label that she had been given, [the doctor] saved her life," Dr. Groopman says.
• Take a holistic approach. Dr. Groopman says a lot can be learned from alternative health practitioners who really look at the big picture. "It's very common that alternative practitioners listen carefully, think about the whole background and the social setting, the nutritional and environmental and work environment—which we're not really focused on in terms of medical education," he says.
• Extend the visit or schedule a second visit. Dr. Groopman says doctors are under extreme time pressures, but if a problem is complicated and the answer not apparent, they can avoid making snap judgments by slowing down. He says patients, too, should see it as a good thing if their doctor asks them to return for another visit.
• Seek a second opinion. Dr. Groopman says doctors working in group practices have the advantage of getting input and varying perspectives from their colleagues.

Dr. Groopman shares a few simple questions that a patient or a patient's friend or family member can ask to make sure the doctor is thinking as openly as possible:

• What else could it be? Because we use shortcuts in thinking and so frequently anchor our minds to first impressions, Dr. Groopman says this question will help challenge your doctor and give them pause. "It's particularly relevant if the treatment's not working, the symptom doesn't go away or there doesn't seem to be a resolution," he says.
• Could two things be going on at the same time? Dr. Groopman says doctors are taught to use Occam's razor—a rule that states one simple explanation is usually the correct one—when in fact, more than one problem could be going on. "Many of the patients we see have multiple problems," he says.
• Is there anything in my history/physical exam/lab tests/X-rays that seem to contradict your working diagnosis? Dr. Groopman says this question is important because the other trick that our mind plays is confirmation bias, meaning, we tend to confirm what we're expecting. "We cherry-pick the information that we look at to satisfy ourselves that our initial impression is correct," he says.