Poker Medicine

March 26, 2013
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I was sitting across from a large man, covered with tattoos, wearing a Stetson, a bolo tie and reflector sunglasses.  He was breathing slowly, his face barely moving.  Clearly he was not going to help me with my quandary.   I looked at my pocket cards and I was holding a pair of jacks.  When I raised the pot, he called without hesitation.  I looked down at the board, and watched as a jack, a 10, and a nine appeared. Although my trips look good, clearly I could be beaten.   I made another large bet, and got called again.  As I pondered what this guy could possibly have, I reflected on how poker was so similar to medicine.

In medicine, we try to make logical deductions from the evidence we see.  We ask questions, perform tests, ask more questions, perform more tests, until the likelihood of a particular diagnosis is correct.  However, in many circumstances, we can almost never be absolutely certain of the diagnosis.  Our history-taking skills and examination skills gets as close as possible to understanding what illnesses are likely to be present.  Very sophisticated laboratory tests, such as antibody tests, PET scans, MRIs, nuclear stress tests, etc. give us answers but are rarely so specific that the diagnosis is unequivocal on the basis of a test alone.  This is quite difficult for many patients to understand.  For example, the patient with chest pain that is not typical of heart attack, who is worried that this may be heart disease, wants to obtain a stress test to “rule it out.”  Unfortunately even the best stress test cannot completely rule out heart disease in all cases.  And in fact, many stress tests especially in a middle-aged man are falsely positive, giving a patient a huge amount of anxiety unnecessarily.  It doesn’t mean we shouldn’t do some of these tests, however it does mean we need to be cautious interpreting their meaning.

The logic behind medical decision-making and behind poker decision-making is based on the same mathematical principal of Bayes theorem, which enables us to make predictions based on prior probabilities and conditional probabilities.

Beyond that, poker tells are just like clues a doctor reads when a patient enters the room.  Did that guy with back pain, asking for a disability extension, just hop on the table as if nothing were bothering him?  Everything from skin texture, to voice changes, spontaneous movements, eye contact, etc., is processed by us in some way to make judgments about what the nature of the patient’s problem is.

As a four hit the board and another four hit the board, my full house was looking pretty good.   When I pushed all in, I was pretty surprised I got an instant call.  What could he possibly have?   As I showed my jacks, I looked across the table.  A pair of fours gave him quads—four fours.  I’d better stick to medicine.

About Norman Solomon, M.D.


Norm Solomon, M.D., has been the medical director at the MPTF Westside Health Center since 1995.

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