The Invisible Gorilla by Christopher Chabris

Author:Christopher Chabris [Chabris, Christopher]
Language: eng
Format: epub
ISBN: 978-0-307-45967-1
Publisher: Potter/Ten Speed/Harmony/Rodale
Published: 2010-05-17T16:00:00+00:00

Causes and Symptoms

Unlike the parade of unusual patients appearing on television dramas like Grey’s Anatomy and House, or coming to Dr. Keating’s St. Louis diagnostic clinic, the vast majority of the patients whom doctors see on a daily basis have run-of-the-mill problems. Experts quickly recognize common sets of symptoms; they’re sensitized to the most probable diagnoses, learning quite reasonably to expect to encounter the common cold more often than an exotic Asian flu, and ordinary sadness more often than clinical depression.

Intuitively, most people think that experts consider more alternatives and more possible diagnoses rather than fewer. Yet the mark of true expertise is not the ability to consider more options, but the ability to filter out irrelevant ones. Imagine that a child arrives in the emergency room wheezing and short of breath. The most likely explanation might be asthma, in which case treating with a bronchodilator like albuterol should fix the problem. Of course, it’s also possible that the wheezing is caused by something the child swallowed that became lodged in his throat. Such a foreign body could cause all sorts of other symptoms, including secondary infections. On shows like House, that rare explanation would of course turn out to be the cause of the child’s symptoms. In reality, though, asthma or pneumonia is a far more likely explanation. An expert doctor recognizes the pattern, and likely has seen many patients with asthma, leading to a quick and almost always accurate diagnosis. Unless your job is like Dr. Keating’s, and you know that you’re dealing with exceptional cases, focusing too much on the rare causes would be counterproductive. Expert doctors consider first those few diagnoses that are the most probable explanations for a pattern of symptoms.

Experts are, in a sense, primed to see patterns that fit their well-established expectations, but perceiving the world through a lens of expectations, however reasonable, can backfire. Just as people counting basketball passes often fail to notice an unexpected gorilla, experts can miss a “gorilla” if it is an unusual, unexpected, or rare underlying cause of a pattern. This can be an issue when doctors move from practicing in hospitals during their residencies and fellowships to practicing privately, especially if they go into family practice or internal medicine in a more suburban area. The frequencies of diseases doctors encounter in urban teaching hospitals differ greatly from those in suburban medical offices, so doctors must retune their pattern recognizers to the new environment in order to maintain an expert level of diagnostic skill.

Expectations can cause anyone to sometimes see things that don’t exist. Chris’s mother has suffered from arthritis pain in her hands and knees for several years, and she feels that her joints hurt more on days when it is cold and raining. She’s not alone. A 1972 study found that 80–90 percent of arthritis patients reported greater pain when the temperature went down, the barometric pressure went down, and the humidity went up—in other words, when a cold rain was on the way. Medical textbooks used to devote entire chapters to the relationship between weather and arthritis.

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