本周经典推荐- Where Doctors Go Wrong

莫斯科的泪 · 发表于 2007-3-28 00:38:00

<table cellspacing="1" cellpadding="1" width="700" summary="" border="0"><tbody><tr><td valign="top" align="left" width="450">The patient was an 8-year-old California girl with severe headaches. Her parents, who were both struggling to adjust to new high-pressure jobs, took her to top neurologists and pediatricians. The child's symptoms, the doctors concluded, were a response to stress at home, along with perhaps a sinus condition. But four or five months later, it became clear that she had a brain tumor and needed surgery. When her doctors looked back at early scans of her brain, they were aghast to see the shadow of a tumor they had previously overlooked.For Harvard hematologist Jerome Groopman, who is a friend of the child's parents, the missed diagnosis was more than just a cautionary tale. It was the start of an investigative journey. "

eople talk about technical errors in medicine, but no one talks about thinking errors," he explains in an interview. "I realized I had no framework for understanding these kinds of problems."For the next three years -- in addition to seeing patients and doing research, plus his gig as a staff writer for the New Yorker--Groopman began to intensively examine how doctors think and how they get sidetracked from the truth. He learned that about 80% of medical mistakes are the result of predictable mental traps, or cognitive errors, that bedevil all human beings. Only 20% are due to technical mishaps--mixed-up test results or hard-to-decipher handwriting--that typically loom larger in patients' minds and on television shows.The result of Groopman's journey is How Doctors Think (Houghton Mifflin; 307 pages), an engagingly written book that is must reading for every physician who cares for patients and every patient who wishes to get the best care. Groopman says patients can prompt broader, sharper and less prejudiced thinking by asking doctors open-ended questions and learning to identify some of their common thinking mistakes:ERROR 1: I RECOGNIZE THE TYPEDoctors, like most of us, are often led astray by stereotypes that are based on someone's appearance, emotional state or circumstances. Thus a homeless man's disorientation might be quickly attributed to alcoholism when the real culprit is diabetes.Groopman describes this kind of "attribution error" in the case of a nervous young woman who kept losing weight even when prescribed a high-calorie diet. Her doctors, convinced that she was lying about her food intake, suspected anorexia or bulimia, but her problem, diagnosed after years of ill health, turned out to be celiac disease--an allergy to wheat. Had the patient been male or older or less anxious, the doctors might have got it right in the first place.ERROR 2: I JUST SAW A CASE LIKE THIS"We all tend to be influenced by the last experience we had or something that made a deep impression on us," Groopman says. So if it's January, your doctor has just seen 14 patients with the flu and you show up with muscle aches and a fever, he or she is more likely to say you have the flu--which is fine unless it's really meningitis or a reaction to a tetanus shot that you forgot to mention.The best defense--besides giving as complete a history as you can--is to be alert and ready to ask questions anytime a doctor says, "There's a lot of this going around."ERROR 3: I'VE GOT TO DO SOMETHING

hysicians typically prefer to act even when in doubt about the nature of the problem. And yet this kind of "commission bias" can lead to all sorts of new problems if the treatment turns out to be incorrect."Don't just do something. Stand there," one of Groopman's mentors told him years ago when he was uncertain of a diagnosis. This buys a doctor time to think--which is especially important when trying to ensure that something hasn't been overlooked.ERROR 4: I HATE (OR LOVE) THIS PATIENTGroopman cautions that emotions are more of an issue than most physicians like to admit. Doctors who are particularly fond of a patient have been known to miss the diagnosis of a life-threatening cancer because they just didn't want it to be true. But negative emotions can be just as blinding, sometimes stopping a doctor from going the extra mile. "If you sense that your doctor is irritated with you, that he or she doesn't like you," says Groopman, "then it's time to get a new doctor." Studies show that most patients are pretty accurate in describing their doctors' feelings toward them.Groopman's book makes abundantly clear that despite all the electronic databases that are being used to improve health care, a lot of medicine still comes down to a doctor or two puzzling out what might be wrong with your body. Experience, common assumptions and human nature can guide them or lead them astray. By asking a few questions--especially if you think your doctor isn't asking enough of them--you can raise the odds that your physician won't get detoured from the truth.</td><td> </td><td valign="top" align="left" width="220"> neurologist: 神经科专家 pediatrician: 儿科医生 symptom: 症状 sinus: 鼻窦 tumor: 肿瘤 surgery: 外科手术 aghast: 惊骇的；目瞪口呆的 missed diagnosis: 误诊 cautionary tale: 警戒性的事件 framework: 框架 gig: （俚语）工作 sidetrack: 岔开思路 mental trap: 思维陷阱 cognitive error: 认识上的错误 bedevil: 迷惑 mishap: 不幸事件 hard-to-decipher: 难以看懂的 loom: 突出 engagingly: 吸引人的 must reading: 必读的 prompt: 激励；促成 prejudiced: 带偏见的 open-ended: 广泛的 astray: 歧途 stereotype: 陈规；固定不变的模式 disorientation: 迷失方向 culprit: 罪犯 diabetes: 糖尿病 prescribe: （医生）指定；开处方 high-calorie: 高卡路里的 convince: 确信 anorexia: 厌食 bulimia: 易饿症 celiac disease: 因不能消化谷蛋白粘胶质引起慢性营养不良 allergy to wheat: 对小麦过敏 meningitis: 脑膜炎 tetanus shot: 破伤风针 alert: 警惕的 physician: 内科医生 commission bias: 行为偏差  mentor: 导师 This buys a doctor time to think: 这为医生赢取了思考的时间 blinding: 使人失去判断力的 assumption: 假定；设想 raise the odds: 提高几率 detour: 迂回；绕道</td></tr><tr><td>www.learnmore.com.cn</td><td> </td><td> </td></tr><tr><td valign="top" align="left" bgcolor="#ffffcc"> 值得学习的词汇： syptoms: 症状 gig: （俚语）工作 buy time: 赢得时间；争取时间； 例如：Renting an apartment buys them time to look around for a new house. 先租一套公寓使他们争取到时间寻找新房子。 raise the odds: 提高几率；增加机会 例如：A good reference letter will definitely raise the odds of you getting into Harvard。有好的推荐信,一定能提高你进入哈佛的机会。 值得学习的句型： ... emotions are more of an issue than most physicians like to admit. 个人感情这个问题的重要性超出了医生们可能承认的限度。 be more of an issue than: 比......更重要；例如： Fire safety may be more of an issure in a factory than a bedroom. 对于一家工厂而言，防火安全恐怕要比卧室问题更重要。 </td></tr></tbody></table>

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本周经典推荐- Where Doctors Go Wrong

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