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How doctors (and nurses) think.

IN HIS BOOK How Doctors Think (Houghton Mifflin, 2007), Jerome Groopman provides wonderful stories of the good and bad thinking processes of physicians of all specialties. One of the most striking characteristics of good thinkers is curiosity. Those who ask questions, who think outside the box, who avoid jumping to pat diagnoses or treatment decisions, are lauded for their successful thinking behaviors. Groopman refers to the uncertainty of the expert as an important component of good thinking among physicians, an uncertainty that leads to withholding judgment, rather than relying on exact responses programmed through technology.

What is most interesting about this portrayal of physician uncertainty is the proposition that experts are most often not aware of their own questioning. In other words, they have learned to act as if they are certain in their clinical judgments. Most importantly, there is the delicate balance of being confident and yet sharing with patients the questioning mode that helps both patient and provider find the answers. Groopman argues that acknowledging uncertainty may enhance the therapeutic relationship between provider and patient.

Especially important in this book are stories told of the constant search for solutions that lead to new ways of putting symptoms together and physicians who solve medical puzzles for patients when other providers have failed. Those of us who have been in nursing for many years have our own collection of stories. Perhaps we know of a nurse who continued questioning the treatment initiated for a critically ill patient who did not respond as expected, or a public health nurse who identified the complexity of a family situation that led to poor health outcomes for the children.

Excellence in nurse thinking has the same components. As educators, we are challenged to encourage our students to ask questions and avoid looking for immediate answers without initiating the necessary investigation. We use probing questions in our classrooms to teach students the skills they must develop to gain important information from their patients. At the same time, we help them develop skills that will lead them to expertise in their clinical judgments.

Groopman also delineates the characteristics of successful behaviors that physicians use, including structured time management techniques and clear communication with others. The best health care practice for both nurses and physicians requires clinicians who are skilled in behaviors that complement their scientific and technical knowledge. As nurse educators, it is well worth our attention to help students develop not only the knowledge and skills they need to practice safely and proficiently, but also the professional behaviors they need to exhibit to earn the trust of patients and families. We would want no less from our nurses than we would expect from physicians.
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Title Annotation:FROM the Editor; How Doctors Think
Author:Fitzpatrick, Joyce J.
Publication:Nursing Education Perspectives
Article Type:Book review
Date:Nov 1, 2008
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