How People..I mean, Doctors Think

The New Yorker recently posted an essay about ED (emergency department) doctor cum experimental psychologist Dr. Pat Croskerry concerning the flawed heuristics (manner of approaching an investigation in this context) doctors bring into the doubt-riddled and often misled diagnosis process (please don't ever lie to your doctor about just how hard you work to dick yourself up). It's an easy read, telling stories of the atypical patients that are misdiagnosed before waxing theoretical, and I strongly suggest you read it.

The essay brings up three particular heuristics:
1. "Representativeness" a.k.a. expecting what's true most of the time to be true
2. "Availability" a.k.a. following trends in recently admitted patients
3. "Affective Error" a.k.a. liking your patient too much (WTF?)

Now, I don't approach the essay as a polemic, but it is critical in tone and, like many critiques, lacking in suggestions for remedial action. The first two heuristics are simply good logic, and warping the physician's approach to diagnosis in an attempt to prevent the percentage of errors it causes would undoubtedly be extremely expensive. The majority of patients that create a sense of "representativeness" or "availability" would undergo additional testing to rule out "unrepresentativeness" and, well, that'd be fucking awful considering the number of uninsured patients and universally accepted bloat of American healthcare.
It's a classic question: Do we punish the majority for the sake of the minority? As always, it becomes a matter of weighing advantages and disadvantages. Until better and cheaper diagnostic tools become available, error is inevitable in the attempt to run an efficient (and in this case that means life-saving) operation. I purposefully omit often-proffered solutions, such as colleague oversight, because they don't apply to the premise of the essay. In no way does this indemnify substandard doctoring (as is seen in the second two examples of the essay), but believing your doctor is malfeasant in expecting the norm absent of other risk factors can only raise the expected standard of care to a level the current technological and legal environment (think: $$) cannot support. You don't see the bill for a patient of House M.D.

I do think the technology is in the pipeline, so despair not, but that's another post.

Anyways, as always, I invite contrary opinions. I'm just beginning to wrestle with this issues, and I recognize the limitation of my understanding and the benefit of a little intellectual adversity. Also, Nelly Furtado gives me an ambiguous-ethnicity-beauty chubby.