and she said.. "how you interpret the dream is probably more important than the dream itself"

Last Friday on the NPR show Fresh Air I heard part of an interview with a doctor who was discussing the failings of modern medicine, the lack of think different mentality, and the tendancy of doctors to miss things because they are following the prescribed testing regime too closely (link to audio here). Surprise surprise, medicine is not easy. Apparently you should be smart to practice it. Apparently, you should not follow the rules like they were a high school football playbook.

Most interesting were the anecdotal stories, but I've now discovered that the same guy, Dr. Jerome Groopman (bio here; he has an impressive resume), has written a book on the matter (which explains why he was being interviewed) and he even has a piece in the New Yorker which is making the rounds on this here innnernector wagon-train of digital pipes, straws, and wirey thingys that go beep in the night. It is titled What's the Trouble? How Doctors Think:

Brad was my favorite patient on the ward. Each morning when I made rounds with the residents and the medical students, I would take an inventory of his symptoms and review his laboratory results. I would often linger a few moments in his room, trying to distract him from the misery of his therapy by talking about literature..

.. One morning, Brad developed a low-grade fever. During rounds, the residents told me that they had taken blood and urine cultures and that Brad’s physical examination was “nonfocal”—they had found no obvious reason for the fever..

.. Two residents helped prop Brad up in bed so that I could examine him; I had a routine that I followed with each immune-deficient patient, beginning at the crown of the head and working down to the tips of the toes. Brad’s hair was matted with sweat, and his face was ashen. I peered into his eyes, ears, nose, and throat, and found only some small ulcers on his inner cheeks and under his tongue—side effects of his treatment. His lungs were clear, and his heart sounds were strong. His abdomen was soft, and there was no tenderness over his bladder..

.. ater that day, I was in the hematology lab, looking at blood cells from a patient with leukemia, when my beeper went off. “Brad Miller has no blood pressure,” the resident told me when I returned the call. “His temperature is up to a hundred and four, and we’re moving him to the I.C.U.”

Brad was in septic shock. When bacteria spread through the bloodstream, they can damage the circulation. Septic shock can be fatal even in people who are otherwise healthy; patients with impaired immunity, like Brad, whose white-blood-cell count had fallen because of chemotherapy, are at particular risk of dying.

“Do we have a source of infection?” I asked.

“He has what looks like an abscess on his left buttock,” the resident said..

.. The abscess must have been there when I examined Brad. But I had failed to ask him to roll over so that I could inspect his buttocks and rectal area..

.. I was furious with myself. Because I liked Brad, I hadn’t wanted to add to his discomfort and had cut the examination short. Perhaps I hoped unconsciously that the cause of his fever was trivial and that I would not find evidence of an infection on his body. This tendency to make decisions based on what we wish were true is what Croskerry calls an “affective error.” In medicine, this type of error can have potentially fatal consequences. In the case of Evan McKinley, for example, Pat Croskerry chose to rely on the ranger’s initial test results—the normal EKG, chest X-ray, and blood tests—all of which suggested a benign diagnosis. He didn’t arrange for follow-up testing that might have revealed the source of the ranger’s chest pain. Croskerry, who had been an Olympic rower in his thirties, told me that McKinley had reminded him of himself as an athlete; he believed that this association contributed to his misdiagnosis.

It's worth a listen, if only to convince yourself that second, third, and sometimes fourth opinions may not be as crazy as you'd think. Medicine is advanced, but it doesn't collectively have all the answers - so why would one single doctor?