Megan McArdle and eSkeptic have written pieces implying that Groopman has missed an important point. KevinMd seems to agree – “Doctors do best when they treat their patients by the numbers”
McArdle’s rant here – You think too much
I very much enjoyed Jerome Groopman’s book, How Doctors Think. I love his writing at the New Yorker. But I am afraid I didn’t think very much of the book’s thesis, which is that doctors need to improve their clinical judgement rather than relying on evidence based medicines and statistics. “People are not statistics” is sloppy thinking; most of the time, we are. And there’s substantial evidence that doctors do best when they treat their patients by the numbers.
She links to How Doctors Think They Think
The critiques miss the point. They miss the point because they do not practice medicine. They assume that we know what is wrong with the patient.
Groopman’s book is more about the diagnostic process than about treatment decisions. EBM rarely tries to guide diagnosis. I have cited important articles about diagnostic errors previously. Groopman stresses the importance of correct diagnoses.
He also mentions, and I will emphasize, that EBM works best when patients have one disease. But many adult patients suffer multiple problems. We really do not know how to apply EBM to multiple diagnoses, because we do not have appropriate data.
There are evidence based indicators which we should follow (ASA for CAD, colon cancer screening above the age of 50, ACE inhibitors for proteinuria). However, most patient interactions are not covered by such indicators.
As physicians we have many opportunities to make mistakes, even if we apply EBM religiously. If we do not make the right diagnosis, we have lost the battle before we choose therapies.
Groopman’s book is important because he stresses diagnostic acumen. McCardell and Lambdin construct fallacious straw man arguments against the book. Perhaps they are being controversial. Perhaps they do not get the point. Nonetheless, their criticism of Groopman does not speak to his main points. And KevinMD should understand this.
