Author Malcolm Gladwell is a master of the fascinating factoid - which often gives an insight into, or is relevant to, the practice of medicine.
My sister just gave me ‘Blink’ - subtitled “the power of thinking without thinking”.
It’s all about how we make decisions about things, and particularly instant decisions - or “thin slicing” as he calls it. Some subliminal process is going on where we are thinking about, and making a judgment about, someone or something without realizing it.
He sites numerous examples of where this occurs - by art critics, by cops in arrest situations, in music auditions and many other situations. I think this may be the explanation for the little voice in my head that is telling me what is wrong with someone, or more particularly, that just pops the name of a medicine into my mind, for no apparent logical reason.
I will be sitting before a patient and suddenly the name Zoloft or Coreg or Topomax will suddenly come to mind - well before I have gone through the whole rigmarole of history and examination and then computing it all for the “assessment and plan”.
Another factoid he sites is how you can make a fairly good assessment of a person, not by meeting them, but by looking at their surroundings.
He sites a study where the personality of students was remarkably accurately assessed by looking at their rooms - if they are anything like some of the student rooms I have seen in my time, this could be a dangerous thing to do.
The relevance of this to the practice of medicine, is that it vindicates what is said about the benefit of the lost art of house calls. That you gather all sorts of information about the patient that you would not have if they just come to the office and you don’t see their home environment.
You see their wound infection’s not clearing up because of the unsanitary conditions. That they’re not getting any rest because they’re next to the interstate. That they’re fighting with their wife. The pile of pizza boxes and empty fridge indicate a crappy diet. That the garbage is cram full of beer cans. That there are numerous loose rugs and obstacles that will lead to falls - and so on, in your Sherlock Holms-ian way.
Finally he discusses the conundrum of how it’s not the degree of skill or how many mistakes a doctor makes that predicts if he/she will get sued.
He talks about a study of conversations between surgeons and patients - that were dickered with so that you couldn’t even hear the words - just the tone of voice.
It would appear it is the doctor who adopts a dominant tone that incites patients to sue him or her.
