October 9th, 2014

Why Bad Doctors Are Like Bad Writers: The Curse Of Knowledge

Steven Pinker, the Harvard psychologist and best-selling author, has a wonderful essay in the Wall Street Journal about why smart people are so often bad writers. Although the essay doesn’t touch on the subject of doctor-patient communication, every single word applies to doctors and the way they communicate (or fail to communicate) with their patients.

Here’s the core of Pinker’s argument. Read the rest of it. And if you’re a doctor and you don’t see how this is relevant to how you communicate with your patients then you need to think again.

“In explaining any human shortcoming, the first tool I reach for is Hanlon’s Razor: Never attribute to malice that which is adequately explained by stupidity. The kind of stupidity I have in mind has nothing to do with ignorance or low IQ; in fact, it’s often the brightest and best informed who suffer the most from it.”

Pinker goes on to describe a professor giving a lecture on a recent breakthrough in his field to a large general audience. “He launched into a jargon-packed technical presentation that was geared to his fellow molecular biologists, and it was immediately apparent to everyone in the room that none of them understood a word and he was wasting their time. Apparent to everyone, that is, except the eminent biologist… Call it the Curse of Knowledge: a difficulty in imagining what it is like for someone else not to know something that you know.”

From the archives of the New England Journal of Medicine, here are two more worthwhile perspectives about doctors abusing language:

In 1975 Michael Crichton, the best-selling novelist and MD, neatly dissected the various forms of language abuse he found in, of all places, NEJM itself.

In 1979 Nicholas Christy wrote about Medspeak.

What do you think?

6 Responses to “Why Bad Doctors Are Like Bad Writers: The Curse Of Knowledge”

  1. Why isn’t the answer as simple as practice and talent? I do not understand why writing and public speaking is viewed differently from piano playing and golf.

    The reason I am not good at golf is because I do not have a raw talent for it and I have not spent enough dedicated time practicing it….. However, I was good at football (the one you play with your feet). When it comes to writing and speaking, some people are not good at it and other people are….and then you get people who are excellent at it, like Larry and Harlan. So I do not think it is a curse of knowledge….although the next time I slice my ball onto the wrong fairway, I am going to attribute that to the curse of knowledge!

  2. the reasons’s are,

    1. at the start of practice, a doctor doesn’t have enough of confidence & conviction about his diagnosis/ prescription but is eager to earn a lot. thus fails in doctor – patient communication whether verbal or wriitten (prescription)

    2. by the time he is mature enough he realises, that it (coomuncation) doesn’t make a diffrence, therefore he insists on bare minimum.

    here comes the role of team built around a doctor, it helps in better, meaningful and easier communication.

  3. John, one of the phenomena that Pinker explicates beautifully is why even the talented, the brilliant, and the experienced fall into needlessly common traps that are utterly disrespectful to readers. Talent and practice are important factors, of course, but Pinker identifies other more insidious, and potentially more powerful, social and psychological ones in his essay. Of course, Pinker himself falls into one or two of those insidious traps (and he must know that), but he masks the evidence deftly with his nearly unmatched talent for expository writing.

    However, although I largely agree with Larry that physician-writers make the mistakes (outlined by Pinker) that other academic writers do, I think that the social and psychological explanations do not apply quite as precisely to physicians as to writers in, say, the humanities and the social sciences, where the enterprise of writing well is at the core of the professional mission.

    Incidentally, I originally read the essay in the Chronicle of Higher Education, not the WSJ. I wonder if the versions are identical.

  4. Enrique Guadiana, MD says:

    It’s not the curse of knowledge. It’s the curse of diversity. Everybody is different. Words and letters need interpretation. Yes, We have dictionaries but most of the people didn’t learn to talk and write in dictionaries. So everything has to be interpreted by our brain. The interpretation is susceptible to have different meanings because by definition is an interpretation. You have to consider the culture, education, experience, sex, age, personality, native language, etc. You need to acknowledge and embrace the diversity of the human race. Every time you speak or write the information is interpreted by your audience in many many ways. The most important quality of a good writer and a doctor, beside talent and knowledge, is the ability to identify his public. It’s impossible to write a perfect paper for all demographics, etc. diversity is the rule, it’s a blessing and a curse.

  5. Karen Politis, MD says:

    I have always made an effort to communicate well with patients and their families, striving to “lower myself to their level”, explaining the pertinent anatomy, physiology, procedures etc. in simple and concrete terms until their faces light up with understanding. But getting older, the burden of responsibility that goes with seniority drains my resources and energy, and there is never enought time to tend to tasks undone. Often I find myself slipping into the trap of bamboozling people with jargon, just to get the meeting over with, feeling guilt about being so inconsiderate even as I speak. Excellent communication, especially with patients and their families who are frightened and sometimes desperate for a friendly ear, is rewarding, but takes time and patience, commodities which are scarce in our hectic everyday routine.

  6. Jean-Pierre Usdin, MD says:

    This discussion sticks exactly with your headline “Inappropriate Cardiac Stress Tests May Cost Half a Billion Dollars a Year”
    Bad doctors make bad written prescriptions…?
    A shot about doctor’s explanation: sometimes well understood sometimes not. A question of time?
    Not only I had a lot of patients who goes to see a colleague, asking for a test I explained in detail that it is not necessary.