Are You a Great Diagnostician?

Batya Swift Yasgur, MA, LMSW

March 27, 2013

An Art, a Science, a Way of Thinking, or a High IQ?

Many factors go into being a good diagnostician. It's been suggested that IQ is a factor, or that you need a photographic memory of all the facts you've crammed into your brain from medical school. Or that you need to attend lots of medical meetings and burn the midnight oil reading the latest research findings.

Certainly, a degree of learning and recalling some of the more esoteric symptoms of unique ailments can affect your ability to make a diagnosis. If you don't have the knowledge to start with, you can't call upon facts that you don't possess.

But experts say there's more to it than that.

New graduates leave medical school crammed with essential clinical information, says Kathryn Montgomery, PhD, Professor of Medicine and Professor of Medical Humanities and Bioethics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, and author of How Doctors Think: Clinical Judgment and the Practice of Medicine (Oxford University Press, 2006). But that's only a fraction of what's needed to be a good diagnostician.

"What's important is how doctors' minds work and how they put things together," Dr. Montgomery notes.

Physicians have to start thinking about their thinking patterns, agrees Jerome Groopman, MD, Professor of Medicine at Harvard Medical School, Boston, Massachusetts, and author of a book also titled How Doctors Think (Houghton Mifflin, 2007). "There are several cognitive flaws in medicine that are so deeply ingrained, most physicians never critically examine their validity."

For example, budding physicians are taught that hoofbeats almost invariably point to horses. "It's statistically true that there are more horses than zebras," comments Hillel Braude, MD, author of Intuition in Medicine: A Philosophical Defense of Clinical Reasoning (University of Chicago Press, 2012). "But there is always an interplay between them."

Dr. Braude compares ignoring the "zebras" to looking for lost car keys under the lamppost because that's where the light is. "Assuming that something is a 'horse' shines the diagnostic light away from true 'zebras.'"

Marianthe Grammas, MD, Clinical Fellow in Geriatric Medicine, Yale University School of Medicine, New Haven, Connecticut, adds, "There is always a differential diagnosis, even if the actual diagnosis seems straightforward. There are always at least 2 possibilities." However unlikely, one could be a zebra.