4 March 2026

How we respond to medicine shapes how medicine responds to us

Our medical minds are established in our formative years

Jerome Groopman and Pamela Hartzband are eminent American physicians. They have also been married to each other for 45 years. Throughout their lives they have maintained starkly different approaches to medical decision-making. Groopman is a self-confessed enthusiast for applying the latest cutting-edge interventions, whereas Hartzband describes an innate bias towards a conservative “less is more” philosophy.

Inspired by kitchen-table discussions, the couple decided to investigate how individuals approach health problems. They interviewed a cohort of patients and identified common threads. People vary in their eagerness for intervention: maximalists want to do everything, now; minimalists prefer to wait and see. Patients also differ in their preference for technological fixes versus natural solutions. And some are “believers”, with a faith that treatment is invariably good, whereas “doubters” have inherent scepticism. These three axes comprise what Groopman and Hartzband call the “Medical Mind”, which they described in their 2011 book of the same name.

It’s not just patients who have medical minds: doctors have them too. Where a maximalist, technological, believer patient encounters a likeminded doctor, they get along famously – albeit that they burn through a lot of medical resources, and the chance of inadvertent doctor-induced harm will be higher. Minimalist, natural, doubter pairings will hit it off just as strongly – with the potential downside of underreacting to problems. But where there is a mismatch of medical minds things can break down, with maximalist, believer patients feeling fobbed off and their minimalist, doubter counterparts disaffected that the answer always seems to be more pills. Doctors, too, unless they have insight, are likely to feel irked by what they perceive as unrealistic demands, or conversely frustrated by patients who don’t follow their advice.

Groopman and Hartzband trace the origins of their own medical minds to their upbringing. Groopman was raised in a science-worshipping family. His father’s premature death from a heart attack solidified his beliefs. Hartzband was born to parents who eschewed processed food and believed exercise to be vital.

While our medical minds are established during our formative years, they can be reshaped by experiences at any stage of life. One powerful influence can be the health issues of people we know. Suppose your doctor urges you to start a regular medication – let’s call it Longevia. You’re a natural doubter: it can’t be healthy to rely on pills. But then you bump into your neighbour looking full of the joys of spring, who regales you with tales of how the same wonder drug has made her feel ten years younger. Maybe you will go to the pharmacy after all. This is termed “availability bias”, where we judge the likelihood of an outcome with reference to examples that come easily to mind, and place great importance on emotional, vivid stories.

In the past, our exposure to availability bias was limited: how often would someone in our immediate circle have experiences relevant to us? But as the investigative health journalist Deborah Cohen describes in her fascinating book Bad Influence, the advent of social media has expanded our immediate circle almost infinitely. Once an algorithm detects interest in a certain health topic, our timelines become saturated with emotive stories on that theme. If positive, these might convince us of the desirability of a certain drug; witness the surges in demand for weight loss jabs or hormone treatments. And it’s not just medications. The current unmanageable clamour for ADHD and autism assessments owes much to the same amplifying effects, people with what would once have been considered personality traits now convinced that there must something diagnosably wrong. The cacophony from our digital neighbourhood can be helpful but it has also the capacity for harm. Either way, it is a powerful force for moulding the modern medical mind.

[Further reading: How we became obsessed with the human face]