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Doctors, albeit very intelligent, can get stuck in patterns of thinking that are rigid and do not allow for integration of new information.  Doctors use heuristics or rules to make life easier. The problem is that reality is more complex than the simplifications that result from using heuristics.

We have devised a strategy that patients can use to guide their doctors into a more integrative form of thinking about their problems. When used, the patient benefits with a deeper more evolved set of decisions about their problems.

Here is a case study:

Rick is a 29 year old executive. He is a fitness fanatic who does triathalons. He was riding his bike when he got the sudden onset of pressure in his head. He almost fell off his bike when he had a blank spell. He went to the ER of a major hospital.

The ER doctors responded appropriately. They thought that he might have had a brain bleed. They did a CT brain and a lumbar puncture. The good news was that Rick had not had a bleed.  He was sent home.

Unfortunately, Rick’s headache returned. He called our medical call centre.  We knew that he should go back to the ER. But we knew that the doctors would likely think about his situation in a routine way. No bleed. No problem.

Here’s what we did:

We called the ER and spoke to the doctor on call.  We suggested to the doctor that Rick might have viral encephalitis. This was unlikely but was a remote possibility. The doctor was resistant to this idea. In fact, he rejected it.

However, when he and his team saw Rick, their thinking changed from No bleed. No problem to “what might this be?”. Is this a complex case? Is this something unusual. What are we missing? There was humility in facing the clinical puzzle and not the arrogance from quickly solving the puzzle with a heuristic.

Their thinking about Rick started to include new information, new options and new possibilities.

The Outcome:

In fact, this trick that we used guided the doctors into deciding that Rick likely had a low pressure headache caused by a small leak in CSF. They suggested a blood patch, but thought that a trial of bed rest might do the trick.


Challenging your doctors with an unlikely diagnosis such as viral encephalitis can cause them to engage in integrative thinking.  They start to think about the periphery. They incorporate new information. This process results in a better, deeper and more evolved decision about care and a better outcome for the patient.