How Doctors Think [Letter] by Timothy Chambers

 

How Doctors Think

Dr. Jerome Groopman ’72, ’76 P&S’ excellent essay, “Flesh-and-Blood Decision-Making” (July/August), highlights a perennial irony: Life is understood backward, but must be lived forward.
Since life is understood backward, classroom lectures overflow with the benefits of hindsight. Thus we peruse case studies that presuppose omniscience, armed with theories presuming omnipotence. But life is lived forward, with all the imperfections that implies. To face a crisis in real time involves limited powers and a shadowy grasp of the facts.
Given such constraints, what else can we do but deploy “heuristics,” which can flexibly adapt as further facts come to light?
While Groopman’s essay focuses on the medical classroom’s inability to impart real-time medical judgment, I wonder whether this might apply more generally — for starters, to ethics, government and business. Even the riverboat pilot, as Mark Twain observed, needs more than mere memory: “There are two higher qualities which [the pilot] must also have. [The pilot] must have good and quick judgment and decision, and a cool, calm courage that no peril can shake (Life on the Mississippi, 1883).”
By illustrating the difference between classroom instruction and real-time decision-making, Groopman offers not just a portrait of medicine but a picture of the human condition.

Timothy Chambers
Department of Philosophy
University of Hartford (Conn.)