Sometimes I enjoy foraying into lands unknown--principally, that of economics. Despite having never taken an Econ 101 class and somehow stumbling into a job as a financial manager (believe me, even I marvel at the miracle), the subject appears to inform a lot of what goes on in life. Would you believe that doctors make decisions about your health, brokers about your money, and lovers about their next lay using this timeless guideline? Much of this phenomenon is unconscious and masquerades as intuition, gut instinct, or a hunch, but a rose by any other name is just another damn plant.
Let me first describe this glorious little theory beloved by lazy bums the world over. The Pareto Principle, or 80/20 rule, states that "80% of the effects come from 20% of the causes." In business parlance, this means that roughly 20% of your customers account for about 80% of your sales, 20% of a whore's tricks account for 80% of your dirty pleasure, 20% of actual work accounts for 80% of your day, and on ad nauseum. What does any of this have to do with intuition?
Simple. We are wired to filter out only the most salient stimuli around us. When faced with a decision, it is not altogether natural to take into account every possible piece of data and meticulously analyze it in order to find the right course of action. Only economists do that--and as Vilfredo Pareto shows us--even they like to cut the occasional corner. So for all intents and purposes, we make lightning-fast decisions based on clues that we think are important or pertinent to a situation.
For doctors, this means taking careful note of the patient's appearance--whether one is pale, the movement of the eyes and mouth, the timbre of one's voice and how one breathes. As Dr. Groopman puts it, "[Doctors] all develop their hypotheses from a very incomplete body of information...These are called heuristics" (Heuristics being decisions made by "educated guesswork"). Although people would like to believe that physicians possess god-like powers of divination, in reality they are only able to come up with maybe 3 or 4 differential diagnoses upon first meeting you. 5 if they're good.
Why does this matter? For starters, it makes lawyers very happy (20% of whose arguments, by the way, make up 80% of their courtroom BS *coughJohnEdwards*). They can sue doctors if there is any reasonable doubt of an alternative diagnosis (read: must have 100% certainty), and with a few emphatic statements and a little play-acting, it's easy to see why malpractice insurance premiums are so high for specialties like OB/GYN and surgery where the victimized are cute, blubbering babies or your poor gramma. Resulting from all this chaos is the practice of defensive medicine, which drives up health care costs for all. You might not need a CT scan for that stomach pain after all that Tex-Mex and beer, but then again, your appendix could explode. It's just too risky. Better get that $500 scan.
The point of all this is that medicine is not an exact science. As such, we should enact some sort of tort reform that severely limits lawsuits based on misdiagnosis. Physicians are people too, and who's to say that gut intuition is wrong? It's worked on every standardized exam I've taken thus far. And anyway, doctors are aware of the dangers of uncertainty. There is a primal fear of this-- for interns especially.
So let that med student or intern poke the hell out of you. After 20% of the time, 80% of the pain will be gone.
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