Annsley Coleman

Dr. Emerson

IDMD 101

21 September 2026

How Doctors Think Introduction

For my presentation, I covered the introduction to Jerome Groopman’s How Doctors Think, which elaborates on the process of decision making in medicine through Anne Dodge’s personal story. For over fifteen years Anne saw nearly thirty physicians, and they all worked from the same diagnosis (anorexia nervosa with bulimia). She was eating nearly 3,000 calories a day, primarily carbs like cereal and pasta, yet was consistently losing weight. Every doctor read this as noncompliance. Then gastroenterologist Myron Falchuk reopened her case. He ignored previous history reports, and started with a clean slate and active conversation. After he ordered an endoscopy he found celiac disease. Within a month, Anne gained almost 12 pounds. After this, I moved on from Anne’s case and towards Groopman’s larger question of how a physician should reason through a diagnosis. I compared algorithmic medicine with evidence-based medicine and open-ended questioning with close-ended questioning, and looked at how bias and medical intuition can affect diagnosis. Finally, I ended with Groopman’s distinction between misdiagnosis and medical error, where he discussed his own failure in catching a dissecting aortic aneurysm in a patient he found particularly irritating.

The first question the class discussed was the significance of a doctor relying on evidence based medicine versus personal judgement. Unsurprisingly, the class agreed that the most efficient doctor would balance the two. Research is extremely important, but it’s not realistic to treat every patient the same. From here the class went on to discuss and question the process in which medical research is produced in the first place. Fields surrounding women’s health specifically have far less research behind them, and studies that underrepresent women or patients that don’t fall within a specific age category produce diagnostic criteria that is skewed and misrepresents patients. This led us to our next topic of conversation, which was framing. At the end of the discussion, everyone agreed that framing is an effective way to help physicians communicate. Anne’s case, however, is a prime example of what it may cost a person when a physician is almost “protecting” that frame. To keep her diagnosis intact, her doctors decided she was lying about the information she presented them with. More specifically, they assumed she was lying when she said she was eating 3000 calories a day and was actively losing weight. One classmate compared this mindset to p-hacking. We also discussed how this frame affected Anne’s mental state and left her extremely timid and unable to advocate for herself. Towards the end of the discussion, when talking about medical bias, there were a few personal stories that were shared within the context of specific questions. One person shared a story about how a family connection resulted in her brother getting priority for surgery after a knee injury. Another shared how she was rudely brushed off by a doctor for being dramatic. We ended on the reliability of a doctor’s intuition and skepticism and agreed that both are helpful, but need to be checked. We also discussed how storytelling is a great way to get the whole picture from the patient.

Going into my presentation, I thought this topic was pretty straightforward. Doctors should listen to their patients, and that’s the end of the story. The discussion we had during class made this a little more complicated. I never considered how much information diagnostic data leaves out. Early on, the class pointed out that studies underrepresent women and patients who don’t fall in a specific age range. This means the research guiding diagnosis is already missing part of the population. Research is a reliable source, but it isn’t reliable as the only source. A patient’s own account fills in what the studies leave out. Narrative isn’t a soft addition to a “real” diagnosis. It’s data and it’s a way to accurately see how a patient’s health is represented, felt and lived in that specific patient’s body. Anne’s case failed for fifteen years because her story was overwritten by a frame. She told every doctor the same thing. She was eating nearly 3,000 calories a day and still losing weight. That detail should have been a red flag that maybe her frame wasn’t accurate. Instead, her frame put limitations on the plausibility of the information she was giving her doctors. One classmate made a point that in order to preserve the frame the doctors had to assume she was lying. Another person said this incident was similar to p-hacking, which was a comparison that I hadn’t thought about. Anne’s doctors didn’t just accidentally ignore her story. They intentionally removed the one detail that didn’t fit the frame. If narrative is data, then this is data being thrown out. The frame survived because her story didn’t. However, frames aren’t the only thing that can edit a patient’s story. The physician’s own reaction does too. In the reading, Groopman notes that physicians interrupt patients an average of 18 seconds into their story, and our discussion made it clear that who gets heard is relatively dependent on how the doctor feels about the person talking. During this discussion one classmate told a story about how her provider said she was being dramatic after a serious knee injury and had no use for the crutches she was on. She shut down, and the rest of the appointment her mom spoke for her. Anne did the same thing. After years of being treated like a liar she didn’t even want to go see Falchuk. A patient who feels like a burden stops advocating for herself, and from that point on every detail she holds back is data the doctor never gains access to. This is exactly why storytelling matters. It wasn’t that Falchuk necessarily knew more than the thirty previous doctors. He let Anne tell her story from the beginning. One classmate pointed out how much Anne changed during that appointment. She came in timid and closed off, but when Falchuk leaned in and actively listened, her body language opened up and she grew more confident. Storytelling gives patients permission to actually talk, and a patient who feels welcome offers details that a checklist of closed questions is very unlikely to reach. The general population understands their own health as a story. A doctor who encourages that story isn’t wasting time. They are collecting the most complete data they can get and putting the patient back at the center of their own care. Now that a few days have passed and I am reflecting on this discussion, the problem I keep coming back to is that medicine can’t function without frames. But Anne’s case shows that a frame left unchecked stops organizing information and starts deciding what counts as information. I don’t think the answer is getting rid of frames. I think it’s using the patient’s narrative to test them. That doesn’t mean believing every word a patient says, but when the story does not fit the diagnosis, the frame should be questioned before the patient is. No doctor would just toss out an abnormal lab result because it didn’t match the diagnosis. Anne’s report of eating 3,000 calories deserved the same weight. Still, Anne’s case isn’t typical. In most ten minute visits a frame is exactly what allows a doctor to work efficiently, and most of the time it’s right. This is what makes it dangerous. A doctor who is usually right has little reason to check themselves. I still don’t know where the line is or how a doctor learns to notice when a frame has stopped helping, but I think the first warning lies in the patient’s story as long as the doctor is willing to hear it.

Works Cited

Groopman, Jerome. How Doctors Think. Houghton Mifflin, 2007.