HDT

No, not High Definition Television, about which, every time I read an article, I get more bemused. One article will say 'You know, you can get HD local signals over the air; no need for cable or satellite; just use an old rabbit ear antenna', and another will say 'Well, we got our Sony Bravia, but the rabbit ears we'd picked up didn't work, so we bought a ....' Gag me.

This HDT, though, is How Doctors Think, which is the book I'm skimming now -- and the choice of verb should give you a sense of the value of it. Its not bad -- I certainly wasn't looking for anything dense -- but it does like to make the point, repeatedly, that doctors are Noble Folk, that they're dreadfully overworked (which is true, unless, as the book and other sources point out, they've moved into administration part time, which saves their sanity and income, or into retainer medicine, which does that and lets them 'practice medicine the way I want to'), and that they are by nature morally better than those scum over at the insurance companies -- the author actually uses the phrase 'bean counters', but you know thats what he wants to say; wonder how he feels about 'pill-pusher'? - who are, dammit, just interested in money. Imagine!

But for all of that, its an interesting book, because it makes several good points about how doctors make mistakes. (Which really should be the title, but I guess HDT was sexier). He's not talking about technical errors --what's that, doctor? you say the heart is ABOVE the belly button? Well, I'll be damned... -- which he says account for only a very small fraction of errors; instead, he's talking about perceptual errors, where the doctor makes a diagnosis based on a misreading of the patient's actual condition. To be fair, this doesn't happen in most cases; the incidents in the book are where normal medicine isn't quite working; you've got some of the characteristics of this disease, but this disease always has red spots, and you don't have that....although lack of red spots could be a byproduct of this drug, but then again... So its not always an easy thing, making a diagnosis, not to mention the differential diagnoses (what could it be if it isn't what I think it is?), while its very easy to take cheap shots afterward (negligence lawyers do it all the time, I'm told).

When errors occur, he says, its frequently because these bright people misapplied a concept that usually works. For example, if it looks, sounds, and walks like a duck, its probably a duck, even if its does have kind of a black torso and seems to really like eating fish and sliding down hills of snow. And if it happens that I live near a duck sanctuary, then thats proof positive: its a duck. Diagnose based on what is the most likely match, ignore the things that don't match (because those are usually distracting background noise, not useful information), and go for the diagnoses that are the most common. Flu Season? Don't diagnose bronchial cancer when the symptoms are pretty consistant with a chest cold. On the other hand, don't entirely rule it out, either. Sometimes, the hoofbeats really do come from a zebra. And people with colds can have cancer, too.

Overall, not bad.