Doctors' Dilemma

This book is about what goes on in a doctor's mind as he or she treats a patient. The idea for it came to me unexpectedly, on a September morning three years ago while I was on rounds with a group of interns, residents and medical students.

I was the attending physician on 'general medicine', meaning that it was my responsibility to guide this team of trainees in its care of patients with a wide variety of clinical problems, not just those in my own specialties of blood diseases, cancer and AIDS. There were patients on our ward with pneumonia, diabetes and other common ailments, but there were also some with symptoms that did not readily suggest a diagnosis, or with maladies for which there was a range of possible treatments....

I like to conduct rounds in a traditional way. One member of the team first presents the salient aspects of the case and then we move as a group to the bedside, where we talk to the patient and examine him. The team then returns to the conference room to discuss the problem. I follow a Socratic method in the discussion, encouraging the students and residents to challenge each other, and challenge me, with their ideas. But at the end of rounds on that September morning, I found myself feeling disturbed....


I concluded that these very bright and very affable medical students, interns and residents all too often failed to question cogently or listen carefully or observe keenly.... My generation was never explicitly taught how to think as clinicians.

From "How Doctors Think"