How Doctors Think: Why It Matters for Your Health

Inspired by the work of Dr. Jerome Groopman

By Dr. Alain Frabotta — Integrative Chiropractor, Naturopathic & Functional Medicine Clinician, Educator, Sydney, Australia.

When the Diagnosis Isn’t the Answer: Why the Way We Think About Illness Is Failing Patients

Maria was not the kind of patient the medical system was built to understand.

Once bursting with energy, the schoolteacher in her thirties now moved through her days with a body that felt betrayed by its own biology. She woke up exhausted. Rest yielded no relief. Pain offered no pattern. Her hands swung between icy and burning. Her gut was inexplicable. She was living with unanswered questions.

Her lab tests were unremarkable. Her vital signs are normal. Yet her symptoms were undeniable.

What no one asked was what it felt like to live inside Maria’s body. What no one considered was that the real issue might not lie in her organs or data points, but in the way her story was being interpreted — or overlooked — by a clinical process too quick to conclude, too slow to listen.

The failure was not due to a lack of care. It was due to misplaced certainty.

The Diagnosis

We often regard diagnosis as a definitive label — clear, sharp, correct. In truth, diagnosis is more like a working hypothesis: a story that one human constructs about another under time constraints, cultural norms, and subconscious biases.

Dr. Jerome Groopman famously said:

“How a doctor thinks can often determine whether a patient lives or dies.” [1]

But just as profoundly, it shapes whether a patient feels validated or dismissed.

Diagnosis begins as a cognitive act long before it becomes a medical one. It is influenced by a doctor’s upbringing, training, mood, workload, familiarity with certain diseases, confidence, and, most of all, their habits of mind [2].

When that thinking is well-calibrated, patients make progress. When it’s not, people like Maria are left living in the painful space between “nothing’s wrong” and “something clearly is.”

Diagnosis doesn’t fail for lack of data. It fails for lack of reflection.

The Power of Medical Thinking

Medicine is not a purely objective science. It is as much about judgment as it is about labs and imaging.

Have you ever asked yourself:

Why do two doctors sometimes give two different explanations for the same symptoms?
Why can some people’s health journeys feel like a maze while others find clarity quickly?
Why do you sometimes feel a diagnosis doesn’t match your inner experience?

That invisible gap between what you’re told and what you know about your body isn’t simply frustrating — it’s diagnostic. It reflects the cognitive processes of the person in front of you.

In How Doctors Think, Groopman invites us inside the clinician’s mind — to understand how doctors reason, why they sometimes get it wrong, and how their thinking can be reshaped [1]. These insights are critical for anyone living with chronic pain, fatigue, inflammation, digestive issues, autoimmune symptoms, or unexplained symptoms.

Functional Medicine and Naturopathic Medicine take this further — expanding the diagnostic lens, deepening the questioning, and widening the story medicine tells about health.

Clinical Thinking: Where Art Meets Science

Diagnosis is both science and art. Data speaks — but only within context. Symptoms are data points. Stories create patterns.

In other words, how a doctor thinks determines what they see, and what they might completely overlook [1,2].

Cognitive Bias in Medicine: Invisible Barriers to Accurate Care

Medicine excels in crisis. But for chronic, subtle, or lifestyle-related illness, it falls prey to predictable thinking traps known as cognitive biases [2].

These blind spots don't just delay diagnosis — they can lead to misdiagnosis, overmedication, unnecessary procedures, or dismissive care. They’re especially detrimental in conditions that don’t fit neat categories: IBS, fibromyalgia, chronic pain, adrenal dysfunction, leaky gut, inflammation, or stress-related symptoms.

Why Functional and Naturopathic Medicine Think Differently

While conventional medicine often reduces symptoms to labels and treats end-stage effects, Functional and Naturopathic Medicine ask:

“What is the pattern beneath the symptoms?”

Rooted in systems biology, these models explore interconnectedness. They examine how the gut informs the brain, how stress influences hormones, and how the environment shapes inflammation.

Functional Medicine integrates science, advanced diagnostics, and lifestyle intervention to target underlying imbalances.
Naturopathic Medicine brings a philosophy of whole-person care — supporting self-healing, using the least invasive tools first.

Together, they embody Groopman’s more profound message: we improve care not by knowing more, but by thinking better [4].

When 18 Seconds Isn’t Enough

Research shows the average doctor interrupts a patient just 11 to 18 seconds after they begin talking [5-7].

That’s not efficiency. It’s a loss of clinical intelligence.

Interrupting does three things:

Cuts off critical details
Restricts emotional insight
Prevents pattern recognition

By contrast, in Functional Medicine timelines or Naturopathic intakes, patients often share uninterrupted for 30 to 60 minutes — and frequently reveal key clues no scan could ever capture.

That’s not indulgence — it’s diagnostic depth.

What You Can Do: Become a Co-Thinker in Your Healing

Better clinical thinking isn’t just the doctor’s job — it’s a collaboration.

Here’s how you can improve the process:

Tell the Full Story
Describe how symptoms affect your life, when they began, and what changes occurred around that time.
Ask Reflective Questions
- “What else could explain this?”
- “Could these symptoms be connected?”
- “Are there functional or naturopathic models that might help here?”
Allow Silence
Some of the best breakthroughs emerge in the pause after a good question.

Final Reflection: Better Thinking, Better Care

Groopman reminds us:

Medicine doesn’t rise or fall by the number of facts it holds, but by the flexibility of its thinking.

Functional and Naturopathic Medicine honours not only the science of healing but also the story of being human: listen deeper, think wider — and treat the person, not the label.

If you’ve been told “nothing’s wrong,” but you know something is, the barrier may not be your body — but the model you’re being seen through.

It’s time for a different kind of consultation.

+ REFERENCES:

Groopman J. How Doctors Think. Houghton Mifflin; 2007.
Groopman J. What’s the Trouble? The New Yorker. 2007 Jan 29.
Nickerson RS. Confirmation bias: A ubiquitous phenomenon in many guises. Rev Gen Psychol. 1998;2(2):175-220.
Bland J et al. Clinical and scientific principles of functional medicine. Institute for Functional Medicine Textbook of Functional Medicine. 2010.
Ospina NS, Phillips KA. When doctors don’t listen: the importance of patients’ stories. J Gen Intern Med. 2020;35(5):1597-1600.
Rhoades DR et al. Physician-patient communication about complementary therapies. J Fam Pract. 1984;19(5):731-735.
O’Connor P, et al. The “18-second rule” and patient satisfaction. Ann Intern Med. 2019;171(10):757-758.