In How Doctors Think, author Jerome Groopman, MD suggests that in medicine, broad creative thinking may be more important than in almost any other profession.

Doctors are often under agonizing pressure to make decisions in situations where evidence is incomplete or contradictory, where they want to do something, but perhaps shouldn’t. Medical training, overreliance on historic experience and especially new technology may cloud rather than illuminate.

The chapter on radiology discusses how medical innovation can – paradoxically – make medical decision-making more complicated. High-tech multi-slice CT scanners let doctors “see” inside patients. The radiologist who reads the scans is supposed to be able to form quick first impressions without needing to deconstruct each anatomic component on every scan. But the huge amount of imaging data generated by the newest scanners has caused radiologists who review the thousands of pictures taken at fraction-of-a-section intervals to report blurred vision, eyestrain, fatigue and overwork. Error rates are increasing. Are radiologists getting so much complex data that they – literally – miss the forest for the trees?

Groopman says the extraordinary quality of the new scanning technology can lull clinicians – the doctors ordering the scans from the radiologist – into a false sense of certainty. Why should they do a thorough examination or take a patient history when it’s so easy to order a scan and ask the radiologist to make the diagnosis? And clinicians often tailor the language of their requests to keep radiologists “honest.” They don’t tell them specifically what they suspect about the diagnosis, so the radiologist is left to hunt for a needle in a haystack. This can hamper the radiologist’s perception, cognition, technique, and lead to errors.

“People have to understand that there always will be a certain amount of imprecision in imaging and interpretation. Machines cannot replace the doctor’s mind, his thinking about what he sees and what he does not see. Attention to language – the words of a referring clinician and the report of the radiologist – can make perception and analysis better.”

While high tech scanners undoubtedly produce better images that can hasten diagnosis and even save lives, they also make the radiologist’s job much more difficult in terms of image load and data complexity. Radiologists can’t add more hours to their days, so where does the extra time come from to manage the ever-increasing volume?

Food for thought.