ST

Notes on Medicine's Psychological Problems and Remedies

Introduction: story and central thesis

  • True fact about George Clooney: his influence as a public figure is used in the talk to illustrate how appearances can mislead about expertise. Gerald Barnes, the protagonist in the story, rose to Head Physician and Medical Director at Executive Health Group in Los Angeles after 20 years of bedside manner, yet he never went to medical school. The punchline: Clooney taught Barnes how to act like a doctor, not how to be one.
  • Core claim: acting like a doctor does not guarantee medical knowledge or competence; accredited doctors may lack true professional insight. This challenges the assumption that medical training alone guarantees expert judgment.
  • Larger aim: to argue that medicine needs outsiders and a critical look at its psychological problems, not just politics or systems-level debates. The speaker identifies biases, misperceptions, and the hidden factors that influence health outcomes after a patient leaves the waiting room.

Medicine as perception: the doctor–patient relationship and health outcomes

  • After you book an appointment and sit in the consultation room, how you perceive your doctor, and how the doctor perceives you, can influence health outcomes.
  • The talk frames medicine as a psychological problem as much as a scientific one, highlighting the role of perception, trust, and communication in effective care.

Hard facts: what the data say about medicine's psychological problems

  • Money and time with patients:
    • Patients of higher socioeconomic status receive, on average, {20\%} more time with their doctor, along with more positive talk and better explanations of health problems. \left(\text{data: time with doctor correlates with SES}\right)
  • Race and ethnicity in the U.S. medical system:
    • About 13\% of the population identifies as African-American, but only 4\% of medical doctors are Black.
    • Black patients with the same clinical needs as white patients are three times less likely to be referred for cardiac surgery.
    • Within the same hospital and with the same health insurance, Black patients receive fewer catheterizations, fewer angioplasties, and fewer bypass surgeries.
  • Ageism in medicine:
    • While aging is not a sole determinant of treatment need, biology-based assessment is often replaced by chronological age.
    • About half of breast cancer patients are over 65, yet only 8\% of that age group were invited onto drug trials.
  • Obesity bias and its consequences:
    • Approximately one third of the population is clinically obese, yet about 50\% of doctors will label such patients as lazy, awkward, or non-compliant.
    • Obesity is associated with higher cancer risk (e.g., colorectal cancer) and biases in screening:
    • If clinically obese, you have a 50\% increased risk of developing colorectal cancer.
    • Even with the same number of prior medical appointments as normal-weight patients, obese individuals have a 25\% decreased chance of being screened for colorectal cancer.
  • Empathy and treatment compliance:
    • Empathy is recognized by the World Health Organization as a cornerstone of treatment compliance: if a patient perceives that the doctor is listening, they are more likely to listen in return.

Misperceptions in medicine: misdiagnosis, memory, and risk

  • A prominent medical writer and Chair of Medicine at Harvard Medical School is quoted: "I can recall every misdiagnosis I made during my 30-year career." This is presented as evidence that medical professionals may overestimate their diagnostic accuracy.
  • Reality check: studies suggest that between 10\% and 20\% of consultations result in misdiagnoses.
  • Consequence: misdiagnosis deaths in the U.S. approximate 160,000 per year, which some regard as a conservative estimate; this is likened to the impact of four to five September 11th events every month on American soil.
  • The speaker critiques the memory bias that can accompany expertise: exceptional memory for misdiagnoses does not imply that misdiagnoses are rare.

Three main reasons why medicine's psychological problems persist

1) Implicit biases and the erosion of self-awareness

  • The speaker asks the audience to consider standing up if they are racist or ageist; most do not, yet implicit biases are pervasive.
  • Data: around 80\% of Americans say they are not racist, but an implicit association test shows that between 60\% and 75\% display implicit racial biases.
  • The self-serving bias (Lake Woebegone effect): people view themselves as above average in various traits; medicine sits within this bias, giving doctors a biased perception of their own performance.
  • Example: a best-selling NYT medical writer, Groopman, admits misdiagnoses from his long career, which may reflect cognitive biases rather than flawless expertise.
    2) Missing the cognitive revolution: evolution and biology in medicine
  • Doctors are effectively Stone Age minds: Paleolithic instincts shape modern behavior, such as attention bias toward those with more resources, and difficulty sustaining attention to the have-nots.
  • Jerome Barkow's maxim: "Biology is only destiny if we ignore it." Medicine must acknowledge deep-rooted biological predispositions while striving for better reasoning.
  • These evolved tendencies contribute to overconfidence, heuristic shortcuts, and inconsistent decision-making in clinical practice.
    3) The dangerous division between biomedical facts and softer sciences
  • Medical curricula are separated into hard sciences (pharmacology, physiology, anatomy) and softer disciplines (behavioral sciences, ethics, sociology, psychology).
  • The phrase "The art of medicine" carries baggage: it implies individuality, freedom, and an unteachable quality, which can undermine a science-led approach.
  • Alberta medics surveyed said: "Medicine has the scientific part, but the art is the communication aspect"; or that art is about developing one’s own style of communication; or that art differentiates average from really good doctors.
  • Marshall McLuhan: "Art is anything you can get away with." The talk argues we should discard the notion of the art of medicine to avoid unhelpful conceptual baggage and to foreground evidence-led practice.
  • The main critique: medicine must be evidence-led and infused with the human sciences rather than treated as an optional or aesthetic component.

The cognitive revolution and the need for an interdisciplinary approach

  • The speaker advocates injecting human sciences into medicine on an ongoing basis, effectively an intravenous drip of psychology, sociology, ethics, and related fields.
  • The phrase "+injection of the human sciences indefinitely+" emphasizes the need for continual integration rather than a one-off curricular reform.
  • Evolutionary psychology provides a framework for understanding why people behave in biased or suboptimal ways in clinical settings.
  • The goal is not to eliminate biases completely (impossible) but to recognize and mitigate their impact on diagnosis, treatment decisions, and patient communication.

Practical implications and proposed solutions

  • Long-term digitization and decision-support tools
    • Diagnostic software and digital records may help level the playing field across patients of different backgrounds, reducing certain types of disparities.
  • Adopting militaristic introspection techniques to reduce bias in appointment decisions
    • Jack Dovidio’s approach: read a statement to appointment committees to acknowledge and counter implicit bias:
    • Example statement: "We know that there are good female candidates. We know that there are good Black candidates. We don't expect to see underrepresentation of minorities when you're making your appointments, and if we do, we are going to hold you personally responsible."
    • Rationale: such prompts force reflective consideration of implicit biases and can reduce discriminatory outcomes.
  • Empathy and patient-centered communication
    • Patients should aim to communicate in a way they want to be spoken to, and expect reciprocal listening from doctors.
    • If a doctor does not listen or behaves disrespectfully, patients should flag the issue; if unresolved, they should seek another doctor who provides the appropriate attention.
  • Advocacy and self-advocacy
    • Patients can be their own best health advocates by seeking physicians who demonstrate genuine attention and listening.
    • The broader message: medicine needs mindful engagement from patients, doctors, and the health system alike.
  • The broader cultural shift: move toward a mindful, evidence-led practice
    • Medicine should be continually informed by cognitive, social, and ethical insights, rather than treating these aspects as optional or peripheral.
    • The aim is to transform medicine into a discipline that embraces human sciences as a fundamental component of clinical excellence.

Takeaways: how to study and apply these ideas

  • Recognize that poverty of time, biases, and misperceptions can shape clinical outcomes as much as biomedical facts.
  • Use data-driven approaches to understand disparities and to guide improvements in access, treatment, and outcomes.
  • Embrace empathy as a measurable and essential part of patient care, not a soft or optional skill.
  • Be mindful of how language and concepts (like "the art of medicine") shape how clinicians think about their work.
  • Consider systemic strategies (digitization, reflective practices, and inclusive hiring practices) as complements to individual clinician effort.

Conclusion

  • Medicine has longstanding psychological problems that contribute to diagnostic errors, unequal treatment, and suboptimal patient experiences.
  • These problems persist due to implicit biases, evolutionary-influenced psychology, and a disabling division between the science and soft sciences of medicine.
  • A path forward combines digitization, reflective practices, inclusive policies, and a renewed emphasis on empathy and patient advocacy.
  • The call is for a medical culture that is always mindful, evidence-led, and enriched by the human sciences, requiring participation from patients, clinicians, and the wider health system.