This book written by Jerome Groopman fell to my attention thanks to news.google.
I feel this sad joke is based on NT traits. Although it doesn't apply to all cases, doctors frequently make snap judgments based on first impressions, and these first impressions turn them wrong. I quote pieces of various articles which talk about the book.
Example 1
"With a disarming sense of humor, she communicated that she understood she fit a certain social stereotype, and that stereotype had caused her doctors to fail to fully consider her complaints," Groopman notes admiringly of a patient who admitted she was "a little crazy" but doubted that menopause was the cause of her severe headaches and crawling skin. (She turned out to have a tumor that floods the body with hormones.)
Example 2
Dr. Pat Croskerry knew at a glance that the patient in his emergency room wasn't having a heart attack. True, he had a sudden onset of severe chest pain, but Croskerry relied on his initial impression of a trim, athletic man in his early 40s [he looked like "John Wayne"]. His test results were normal, so Croskerry diagnosed a muscle pull and sent him home. He was wrong. The next morning, the patient was admitted to the hospital with an acute myocardial infarct.
Example 3
Consider the account of a thirtysomething woman named Anne Dodge, who for 15 years experienced cramps, nausea and vomiting after eating. Early on, a psychiatrist diagnosed her with anorexia nervosa and bulimia. Repeated consultations with multiple medical specialists over the years didn't alter that assessment.
And yet, there were signs something else might be going on. Dodge insisted she was eating 3,000 calories a day, even while losing weight. The doctors didn't believe that possible. And the young woman clearly pinpointed eating as a source of her distress, describing how intestinal distress followed every meal. But this was thought to be a stress-related problem.
It took a thoughtful gastroenterologist to ponder those inconsistencies and think about the case in a different way.
Maybe Dodge couldn't digest the food she was eating, he proposed, suggesting a new round of tests. They confirmed celiac disease, an autoimmune disorder that makes people intolerant of gluten, a key ingredient of the bread and pasta Dodge was trying to bulk up on.
Example 4 (I add one example from my experience)
My auntie had blood in her feces. She talked to a doctor who said her something on the line "sometimes it happens". The bleeding didn't stop in months, and at the end she found out she had polyps in her colon.
I understand there are time costraints and several other reasons to be fast, and yet there is something more going on.
After consulting the social science literature on the interactions between doctors and patients, Groopman reports that "on average, physicians interrupt patients within eighteen seconds of when they begin telling their story." Beyond being rude, this doctorly impatience often signifies a remarkably brief time between inquiring about a patient's complaints and deciding upon a likely diagnosis and treatment.
The number of ways in which a doctor can screw up make for uncomfortable reading:
"satisfaction of search," the tendency to stop considering alternative explanations once you arrive at a plausible hypothesis
"diagnosis momentum," the unconscious suppression of evidence that conflicts with an existing theory (once a diagnosis is made, it tends to stick and be passed from one physician to another. Other possible medical explanations seem unnecessary, even if the patient isn't getting better)
"commission bias," the preference for action for its own sake
I think these biases are very indicative of NT type of thinking. AFAIK, attraction comes before trust. It is very natural for NTs not to trust people just met, especially because when they first meet someone they are used to joke and banter. Only after a while, after you build rapport, a more serious conversation can have place. Btw, this may cause further harm in that doctors may not give you an unpleasant test just because they are friends.
Another relevant aspect is "congruence". NTs read a lot in body language and voice tonality. They may do it simply because they think they are good at it, or more likely they do it because in this world snap judgements (with some basis on reality) allow some people to survive more than ponderators. If you still want to be taken seriously early, there must be a congruent "aura" the pervades not only what you say but also your entire being. This should be what they called "central coherence". If the wood is a guy who looks like John Wayne, obviously you can't believe the tree that the man is saying that there is something wrong with this heart (this is also why, if you look normal, people won't believe you have AS. They have a strong central coherence).
This bears the irony of the matter: good doctors are people who should trust whatever the patient is saying ignoring their looks, always correct themselves if something shows they were wrong, and disagree with other diagnoses if they don't fit. In short, good doctors are aspies. Groopman is a great guy for the way he inquired the thing, and yet it amuses me how he must have been puzzled by the riddle of the existence of such anti-professional behaviour, and he won't know the most simplistic answer just because he doesn't even know about it.
24 Apr 2007, 10:02 am
