How doctors think, but psychiatrists still a mystery

Dr Jerome Groopman has written a book on the psychology of medical decision making called How Doctors Think but interestingly, he specifically excludes psychiatrists, as he says their thought processes are too complicated to understand.

Groopman talks about his book on the NPR radio programme Fresh Air, which also has the introduction of his book available online.

The end of the introduction is telling:

I quickly realized that trying to assess how psychiatrists think was beyond my abilities. Therapy of mental illness is a huge field unto itself that encompasses various schools of thought and theories of mind. For that reason, I do not delve into psychiatry in this book.

Among the medical profession psychiatry is one of the more poorly paid and less respected specialities, possibly because traditionally ‘dangerous’ medical interventions (such as surgery) are limited, and it often involves dealing with disturbed and difficult patients – which makes it seem less glamorous to the public.

You’ll notice this at election time. Politicians are quite happy to stand next to grateful working folk who’ve just had a life threatening tumour removed, but are strangely reluctant to stand next to oddly behaving unemployed people who’ve just been saved from suicide.

This lack of status belies the fact that psychiatrists deal with the most complex conceptual problems.

There is very little discussion about the philosophy of cardiology because we tend to understand disordered hearts on a limited number of levels.

In contrast, the philosophy of psychiatry is a huge area, because understanding the disordered mind involves drawing together a number of different levels and approaches in the context of one person’s life and experience.

Psychology, neuroscience, sociology, physiology, philosophy, ethics and law are all needed for even the most simple of consultations. And this is just for starters.

This is not to say that other types of medicine are straightforward, but they certainly deal with fewer philosophical difficulties on a day-to-day basis.

This leads to uncertainty and doctors generally hate not knowing what’s happening as it’s often considered a sign of failure.

Psychiatrists, good ones at least, will spend a lot more time saying they don’t know than other doctors. They handle a lot more uncertainty, and this is what makes some physicians uncomfortable.

The fact that someone could write a book on the thought processes of physicians but won’t even attempt to start on the mental life of psychiatrists is, I think, a very sincere compliment.

Link to NPR Fresh Air on ‘How Doctors Think’.