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Views & Reviews Review of the week

Living in a box

BMJ 2007; 334 doi: (Published 19 April 2007) Cite this as: BMJ 2007;334:856
  1. David Woods, editor in chief, Rx Communications
  1. dwoods{at}

    Most medical errors are mistakes in thinking, not in technology, claims a new book, and have a lot to do with the superhuman demands placed on doctors, as well as a measure of arrogance, as David Woods discovers

    How doctors all too rarely think, says the noted oncologist and haematologist Jerome Groopman, is, in the words of the cliché, “outside the box.” This process starts early in the medical training cycle, he says, with medical students and junior doctors all too often failing to question cogently, listen carefully, or observe keenly.

    What's partly to blame for this, Groopman contends, is today's rigid reliance on evidence based medicine and even, to an increasing extent, on highly sophisticated technology that “has taken us away from the patient's story.” To support this notion he points to the sobering statistic that between 1998 and 2002 the number of computed tomography investigations in the United States increased by 59%, magnetic resonance imaging by 51%, and ultrasonography by 50%.

    But it's the sensitivity to language and emotion, he believes, that …

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