Notes on Jerome Groopman, How Doctors Think, 2008. This is not a formal review for publication, just notes on an important book I re-read recently.

Few people have more influence on our lives and those of people in our lives as doctors. So often our first impulse is to trust everything they say as though they had stepped down from Olympus. Yet they are only human. They have their own ways of thinking. They have their own language. They make simple yet catastrophic mistakes.

Jerome Groopman, himself a physician, researcher, and writer of some note, has written an excellent book about how doctors approach medical problems, the intuitions and mental short-cuts they use, and the principles which inform their art. Along the way he gives many excellent examples of successes and failures, all quite instructive. The centerpiece for me was “Surgery and Satisfaction”, in which Groopman recounts his effort to cure a long-standing condition causing pain and debilitation in his right hand. He recounts trips to five different specialists, with widely varying and seldom satisfying results. One tries desultory steps for a year, finally concluding he does not know, and coining a new term to label the condition. One recommends “exploratory surgery” saying “we’ll find out what it is when we get in there”. A third sees the need for three separate surgeries. Along the way Groopman receives one diagnosis of bone cancer in his ribs. If this is the way Groopman, a noted doctor himself, experiences medicine from his peers, what hope to the rest of us have?

For mere “users”, one great value of this book is in its examples of mistakes and successes, which can inspire and empower us. The other great merit is the (astonishingly short) list at the end of questions to ask one’s doctor, such as:

- Could this be anything else? - Are there any symptoms or data which contradict this diagnosis? - Could this be a combination of two or more conditions, not just one?

But enough of medical experiences! The value of this book for IT is the exploration of high-end troubleshooting tactics. Most of the time these days, when a machine acts up, we just replace it. But there will always be instances when this is not an option (CEO, spouse, etc.) and investigation is needed. Groopman explores anchoring, the confirmation error, the attribution error, the satisfaction of search error, and other decision-making mistakes which can all too easily send us astray. There is great value in this book for better troubleshooting in particular, and problem-solving in general.

After reading this, I was struck by how medicine and IT are mirror opposites of one another in how they approach symptoms. Groopman found that specialists saw everything in terms of their own frame of reference, so an oncologist’s first impulse is to see cancer in everything. Of course in IT it’s generally the opposite, as when we describe a problem to the datacenter, and their first impulse is to say “That’s an application issue, not a server issue”, or describe it to the network team, and hear “That’s the hardware acting up, not the network”. I cannot recall Groopman giving a single example of this anywhere is his book.

How Doctors Think is worthwhile for IT folks in examining our own assumptions about how we approach broken things around us. It’s exceptionally valuable for illuminating how we should approach our doctors and health in the most critical of situations.