There’s something you should know about your doctor’s clinical judgement: It relies on a flawed premise. As doctors, our medical education conditions us to look for patterns. Pattern recognition allows us to triage and identify emergencies. It helps us distinguish pulled muscles from heart attacks. It’s a powerful, if imperfect, tool.
Here’s how it works: your doctor walks into the room. You are lying on a gurney, electrodes dotting your chest. “What’s going on?” the doctor asks.
“I’m having chest pain,” you say between gasps of air.
After a few questions, a brief exam, and some routine tests, your doctor judges whether you are destined for the ICU or home. This is pattern recognition in action: mentally placing all the data points into buckets until one bucket grows fuller than the rest.
But there’s something missing here: Your story.
When your doctor asks you these rapid-fire questions, she is thinking about disease. She is not wondering about the kind of person you are or the circumstances of your life. There’s no time for that. And she has been taught that most of the time, those details don’t really matter.
As most clinicians eventually learn, that teaching is wrong. Wrong because it drives us to make assumptions. When we put someone in a bucket, we lump that person together with all the other people who have gone in that bucket before.
In my essay “Breath Sounds,” I describe the assumptions I made about a dying woman. My assumptions began to unravel, however, the moment I entered her hospital room.
Similarly, Tim Cunningham reflects on the temptation to judge a “narcotic seeking” woman in “A Good Night Out.” In the rush to triage, we fall back on familiar patterns because it is easy and gets the job done.
Both essays converge on the revelation that behind the mask of illness lies a person, unique and distinct. Such is the paradox of pattern thinking: even when the pattern fits, it always misses the mark. Every person has a story, and every story is different. This does not mean that pattern recognition has no place in medicine. To be sure, there is no better way to diagnose disease. But we must also retain the humility to see the person behind the pattern.
Blake Gregory, M.D. is a primary care physician and the Associate Medical Director the Adult Medicine Clinic at Highland General Hospital in Oakland, California. Gregory, who is a core faculty member for the Internal Medicine residency training program at Highland, works closely with residents in both the inpatient and outpatient setting. She has dedicated her career to serving vulnerable populations, from her time as Chief Resident at San Francisco General Hospital to her current position with the county hospital in Oakland and believes in the power of writing to process the joys and hardships of practicing medicine.
© 2017 Intima: A Journal of Narrative Medicine