Dichotomous thinking is the natural human tendency to think in a binary manner (either-or). Although it is natural, dichotomous thinking can be simplistic and may lead to a lack of consideration of alternatives. In nuclear medicine, a predominant use of dichotomous thinking can lead to a very elementary way of thinking that may produce technologists who do not question why or how things are done. Adaptation and survival in today's health care environment require complex ways of thinking. This article describes dichotomous thinking and its problems and pitfalls in nuclear medicine practice and education, and suggests that dichotomous thinking can be extended to dialectical (contradictory ideas) modes of thinking.