How Doctors Think

Those on the sales and marketing side are likely to turn to this book for insights of a very different sort (think "quarry"), but the book, How Doctors Think, by Jerome Groopman (click here for excerpts from offers insights for managers in any industry, particularly those (like pharma and biotech) where  uncertainty rules.  Below, an article from Harvard Business School's Working Knowledge. Many of you may recognize problems that pharma shares with its key customer base: miscommunication (hearing but not really listening), relying too heavily on pattern recognition, closing the books too prematurely on a root-cause investigation or problem solving.  Below, the original article from HBS' Working Knowledge, and here, a link to an online forum with comments from folks in different industries.

Original Article

Ask an artist how she creates a work of art, and chances are she can't tell you in a way that would enable you to do it. Similarly, managers I've observed over the years have great difficulty dissecting how they make tough decisions. Now we have an intriguing book, How Doctors Think, in which a practicing doctor, Jerome Groopman, describes brilliant diagnoses and treatments. The book is of particular interest because our colleagues at Groopman's institution, the Harvard Medical School, have evidenced a long-standing interest in business school-type case method techniques, including the development of an instructional program based on them. Perhaps most important, Groopman describes how and why doctors sometimes make tragic mistakes. These are mistakes that occur because of miscommunication (the failure to say "tell me again"); too heavy a reliance on pattern recognition; a tendency to draw on stereotypes to make decisions regarding patients; premature closure of problem diagnosis, possibly because of too heavy a reliance on first impressions; framing effects (biases or preconceptions caused by others' opinions or diagnoses); and availability (judging on the basis of the "ease with which relevant examples come to mind"). In his words, the diagnostic process is even "compromised by positive or negative feelings we have toward another person." Putting it bluntly, research has shown that doctors are more patient when diagnosing people who are not seriously ill, troublesome, or chronic in their complaints. And getting things right takes time, time that many doctors just don't have (or think they don't have). More successful doctors work hard at something called "patient activation and engagement," primarily by asking open-ended questions whose purpose is to engage patients with the purpose "to wake someone up" and signal that the doctor is inviting a dialogue about a patient's ailments. In fact, Groopman asserts that "how a doctor thinks can first be discerned by how he speaks and how he listens"¦his attention to the body language of his patient as well as his own body language." The process proceeds with questions designed to open the exploration of diagnoses that don't fit usual patterns or preconceptions. Its success may depend on questions posed by the "awakened" patient, questions such as "Can I tell you again about how I feel, how it happened, etc.?" "What else could it be?" "Is there anything that doesn't fit?" And "is it possible I have more than one problem?" The very best doctors are able to say, "I believe you when you say something is wrong, but I haven't figured it out," possibly voluntarily sending you on to another doctor for his opinion. This takes time, and good doctors make time to do it. Does this sound like your doctor? Even though doctors may sometimes avoid full disclosure to patients for fear of disturbing them, Groopman asserts that "uncertainty sometimes is essential for success." These observations about doctors raise some interesting questions about how we manage. After all, diagnostics are an important part of managerial decision-making, whether or not someone's life is on the line. What, if anything, can managers learn from Dr. Jerome Groopman's findings and hypotheses? To what degree do they help explain how managers think? Can we learn about good diagnostic procedure by observing our medical counterparts? What do you think? To read more: Jerome Groopman, How Doctors Think (Boston: Houghton Mifflin Company, 2007).