How Doctors Think
Jerome Groopman, a physician at Harvard Medical School, investigates the cognitive errors behind medical misdiagnosis (anchoring, attribution bias, premature closure), and argues for restoring genuine conversation between doctor and patient as the primary diagnostic tool.
Summary
Groopman opens with the case of a woman who was misdiagnosed with anorexia for fifteen years. Every doctor she saw anchored to the previous diagnosis and never questioned it, even as her condition worsened. She eventually saw a doctor who treated her as though she had no prior diagnosis at all, asked basic questions, and discovered she had celiac disease.
The book is structured around the cognitive errors that produce misdiagnosis: anchoring (fixing on the first diagnosis and filtering subsequent evidence to support it), attribution bias (letting a patient's lifestyle or personality affect clinical judgment), commission bias (preferring action over watchful waiting even when waiting is correct), and what Groopman calls "diagnosis momentum," the tendency for a diagnosis to accumulate authority by being repeated across handoffs.
The argument for conversation is specific: the three questions that improve diagnosis most are "What else might this be?", "What am I missing?", and "Is there anything about what you're doing for me that concerns you?", asked of the patient as real inquiry rather than as a formality. Most doctors don't ask them because they feel like admissions of uncertainty. They are admissions of uncertainty, which is the point.
Groopman writes about his own misdiagnoses and the patterns he found in his own thinking. He is the case study about as often as he is the analyst.
Why it stayed with me
The three questions became a template I apply outside medicine. "What am I missing?" as a genuine question, not a rhetorical check, changes how you approach almost any complex problem.