Cognitive Processes in Medical Diagnoses

The following story exemplifies the overall value of thinking and provides a nice introduction to its role in problem solving, and decision making:

Dr. Joyce Wallace, a New York City physician, was having trouble figuring out what was the matter with a 43-year-old patient, “Laura McBride.” Laura reported pain in her abdomen, aching muscles, irritability, occasional dizzy spells, and fatigue. The doctor’s first hypothesis was iron-deficiency anemia, a condition in which there is not enough oxygen-carrying hemoglobin in the blood. There was some evidence to support this idea. A physical examination revealed that Laura’s spleen was a bit enlarged, and blood tests showed low hemoglobin and high production of red blood cells, suggesting that her body was attempting to compensate for the loss of hemoglobin. However, other tests revealed normal iron levels. Perhaps she was losing blood through internal bleeding, but other tests ruled that out. Had Laura been vomiting blood? She said no. Blood in the urine? No. Abnormally heavy menstrual flow? No. As Dr. Wallace puzzled over the problem, Laura’s condition worsened. She reported more intense pain, cramps, shortness of breath, and loss of energy. Her blood was becoming less and less capable of sustaining her, but if it was not being lost, what was happening to it? Finally, the doctor looked at a smear of Laura’s blood on a microscope slide. What she saw indicated that a poison was destroying Laura’s red blood cells. What could it be? Laura spent most of her time at home, and her teenage daughters, who lived with her, were perfectly healthy. Dr. Wallace asked herself, “What does Laura do that the girls do not?” She repairs and restores paintings. Paint. Lead! She might be suffering from lead poisoning! When the next blood test showed a lead level seven times higher than normal, Dr. Wallace had found the answer at last.

To solve this medical problem, Dr. Wallace relied on her ability to think and, more specifically, to weigh the evidence for and against various hypotheses to reach decisions about what tests to order and how to interpret their results.

[Source: Adapted from Bernstein, D.A. (2019). Essentials of Psychology (7th ed.). Belmont, CA: Wadsworth Cengage Learning. p. 238.]

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