Teaching Medical Students How To Think: Narrative, Mechanistic and Mathematical Thinking

Abstract

Computers are becoming better than physicians in some activities. To survive, 21st century physicians need to become better thinkers. The most unique human cognitive skill is the ability to understand other human minds by creating stories about oneself and others (narrative thinking). Narrative thinking is at the core of the art of medicine, and dominated medicine until the 19th century when two types of scientific thinking (mechanistic and mathematical thinking) started to become influential. Mechanistic thinking uses mechanisms (abstract concepts which cannot be demonstrated in experiments but are needed for making hypotheses and interpreting observations from the experiments). In the 19th and 20th centuries, physicians grouped symptoms and signs into syndromes with the hope of separating each syndrome into various diseases based on etiopathological and/or physiopathological mechanisms. The 21st century brought mechanisms based on molecular genetics. Mathematical medical thinking expanded in the 20th century with the tools developed by statisticians. Now data mining and/or machine learning is threatening statisticians.

The traditional teaching of medical students based on the example of a clinician mentor who does not engage in reflective thought may no longer be enough. The three types of medical thinking, narrative, mechanistic and mathematical, need to be incorporated by the 21st century physician, whose thought process should also consider the biopsychosocial model of disease and its center, which is the patient. Computers will never substitute for a self-reflective medical expert who is aware of the strengths and limitations of human beings and of an environment characterized by information overload.