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.)
