Fwd: [IMPROVEDX] Nice discussion (and graphic) on the topic of cognitive bias

Phillip Benton pgbentonmd at AOL.COM
Mon Mar 13 03:57:40 UTC 2017





Mike (et al),

Both  the Cheat Sheet and the Codex we can all certainly relate to, but to me they make even more sense if we look at them through the eyes of Princeton's Nobel laureate  (Economics, 2002) research psychologist Daniel Kahneman (https://en.wikipedia.org/wiki/Daniel_Kahneman).  From his 2011 book Thinking, Fast and Slow, I (perhaps naively) would tend to put all of our cognitive bias into the subconscious "FAST thinking" category, where or brains simply act intuitively, based upon our previous life experiences without any conscious rational thought processes (the follow-up "SLOW thinking" part) . But the FAST thinking (with unconscious bias) frames the SLOW and rational thinking so our decisions wind up bias- tainted, with some variability among different intelligent thinkers (here, physicians) with different backgrounds and experience.  

Maybe if we could engage Kahneman in our pursuit of source(s) of error in medical Dx, we could better understand the task and avoid the 'cognitive traps' he describes in his 2010 TED talk (https://www.ted.com/speakers/daniel kahneman).  Does anyone know Kahneman? Would he help?

My Question: why Is it  not possible take an adverse outcome (death after a 6 day illness from septic peritonitis undiagnosed until autopsy) and overlay the facts recorded in a complete EHR and deduce a probable Root Cause(s) differential in order of probability? This could then guide our possible systems changes to prevent similar errors with similar results.  Is it too naïve to think that an inhuman computer such as Watson would not have such unconscious biases, and could 'reason' purely on the documented factual information in the EHR? Or would some bias be built in by the human non-physician computer programmers?

Phil Benton, MD, JD
Atlanta Medical Center






Sent from my Verizon, Samsung Galaxy smartphone

Sent from my Verizon, Samsung Galaxy smartphone

-------- Original message --------
From: "Bruno, Michael" <mbruno at PENNSTATEHEALTH.PSU.EDU> 
Date: 3/10/17  5:55 PM  (GMT-08:00) 
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG 
Subject: [IMPROVEDX] Nice discussion (and graphic) on the topic of cognitive bias 



Hi all,
 
See the attachment; I am resending this to the list-serve in case there is anyone who hasn’t previously seen it. 
 
I came across this well-organized blog on the cognitive biases last October, and was very impressed with it.  The title is “Cognitive bias cheat sheet.”  It provides a schema to organize the myriad cognitive biases which have been described in the literature, and puts them into a conceptual framework which helped me to make sense of this very complex topic.  I hadn’t heard of the author – Buster Benson – before, but he is clearly a very organized thinker!  He points out that the many cognitive biases with which we struggle in diagnosis actually existfor particular reasons, and they can actually be adaptive under many circumstances.
 
Most of you have seen this before, and so I apologize for the duplication; but I thought it would be of interest for anyone who joined the SIDM list-serve recently, in helping us all to better understand a complex set of mental processes – our biases – which underlie a significant fraction of the diagnostic errors we are prone to make in practice.
 
All the best,
 
Mike
 
PDF is attached; here’s the web link also:https://betterhumans.coach.me/cognitive-bias-cheat-sheet-55a472476b18#.s2j8qandz
 
 
 
Michael A. Bruno, M.S., M.D., F.A.C.R.  
Professor of Radiology & Medicine
Vice Chair for Quality & Patient Safety
Chief, Division of Emergency Radiology
Penn State Milton S. Hershey Medical Center
( (717) 531-8703  |  *mbruno at hmc.psu.edu  |  6 (717) 531-5737

 
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-------- Original message --------From: "Bruno, Michael" <mbruno at PENNSTATEHEALTH.PSU.EDU> Date: 3/10/17  5:55 PM  (GMT-08:00) To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG Subject: [IMPROVEDX] Nice discussion (and graphic) on the topic of cognitive bias Hi all, See the attachment; I am resending this to the list-serve in case there is anyone who hasn’t previously seen it.  I came across this well-organized blog on the cognitive biases last October, and was very impressed with it.  The title is “Cognitive bias cheat sheet.”  It provides a schema to organize the myriad cognitive biases which have been described in the literature, and puts them into a conceptual framework which helped me to make sense of this very complex topic.  I hadn’t heard of the author – Buster Benson – before, but he is clearly a very organized thinker!  He points out that the many cognitive biases with which we struggle in diagnosis actually existfor particular reasons, and they can actually be adaptive under many circumstances. Most of you have seen this before, and so I apologize for the duplication; but I thought it would be of interest for anyone who joined the SIDM list-serve recently, in helping us all to better understand a complex set of mental processes – our biases – which underlie a significant fraction of the diagnostic errors we are prone to make in practice. All the best, Mike PDF is attached; here’s the web link also:https://betterhumans.coach.me/cognitive-bias-cheat-sheet-55a472476b18#.s2j8qandz   Michael A. Bruno, M.S., M.D., F.A.C.R.  Professor of Radiology & MedicineVice Chair for Quality & Patient SafetyChief, Division of Emergency RadiologyPenn State Milton S. Hershey Medical Center( (717) 531-8703  |  *mbruno at hmc.psu.edu  |  6 (717) 531-5737 *****E-Mail Confidentiality Notice*****This message (including any attachments) contains information intended for a specific individual(s) and purpose that may be privileged, confidential or otherwise protected from disclosure pursuant to applicable law.  Any inappropriate use, distribution or copying of the message is strictly prohibited and may subject you to criminal or civil penalty.  If you have received this transmission in error, please reply to the sender indicating this error and delete the transmission from your system immediately.  







Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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