Intellectual humility

robert bell rmsbell200 at YAHOO.COM
Wed Apr 19 04:41:32 UTC 2017


Good point Michael.

Would some overall humility plus intellectual humility increase diagnostic accuracy even further?

Rob Bell
> On Apr 18, 2017, at 11:21 AM, Bruno, Michael <mbruno at PENNSTATEHEALTH.PSU.EDU> wrote:
> 
> Yes, and I think the most difficult part for most people is Step #2 – accepting (and understanding) the level of uncertainty that is always present. 
>  
> I am quite convinced that the root cause of the problem of over-testing (including unnecessary CT scanning) that we all experience on a daily basis occurs mostly because physicians—like most people—are extremely uncomfortable with uncertainty.  Some of the over-testing/over-scanning is also likely related to the practice of defensive medicine, of course, but I am convinced that most of it is done in a futile attempt to attain a higher level of certainty than is actually possible.  Doctors are generally not all that facile with the tools of probability & statistics, which are essentially tools for quantifying uncertainty, but instead tend to think in either/or terms when considering diagnostic possibilities.  
>  
> I’m reminded of a very funny scene from the popular TV show Cheers, which ran from 1982 –1993, in which the character Frasier Crane reads the opening words of Dickens’ A Tale of Two Cities to his friends gathered around the eponymous Boston bar. “It was the best of times, it was the worst of times,” he says.  A long, uncomfortable silence follows. 
>  
> Finally, one of the listeners asks, “Well, which was it?”
>  
> <image001.png>
> 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  |  6 (717) 531-5737
> * mbruno at pennstatehealth.psu.edu <mailto:mbruno at pennstatehealth.psu.edu>  |  
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> From: Grubenhoff, Joe [mailto:Joe.Grubenhoff at CHILDRENSCOLORADO.ORG <mailto:Joe.Grubenhoff at CHILDRENSCOLORADO.ORG>] 
> Sent: Tuesday, April 18, 2017 11:51 AM
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> Subject: Re: [IMPROVEDX] Intellectual humility
>  
> This intellectual humility would certainly be a good defense against sunk costs, search satisficing, confirmation bias. Is not intellectual humility another way of acknowledging uncertainty. Or perhaps acknowledging uncertainty is the next step.
>  
> Step 1: I am humble enough to know that I don’t know everything (knowledge and humility)
> Step 2: Since I don’t know everything, I must acknowledge the uncertainty inherent in my conclusion (uncertainty)
> Step 3: I must gather enough evidence to be reasonably certain of my conclusion (diagnosis)
> Step 4: I must act based on a reasonable amount of certainty (treat)
> Step 5: I must acknowledge that if my treatment does not result in the expected outcome, I must reassess my conclusion (humility, uncertainty, diagnosis, treatment and feedback = calibration).
>  
> This principle of intellectual humility allows the diagnostician to take reasonable action while allowing the diagnostician to reassess. It is equally important in promoting gathering a reasonable amount of additional information and avoiding overtesting. The strong opinion weakly held means that if my treatment of presumed septic shock doesn’t yield the expected results, I might consider something else like PE (a case at our institution).
>  
> Excellent thought exercise. Thanks!
>  
>  
> From: Centor, Robert [mailto:rcentor at UABMC.EDU <mailto:rcentor at UABMC.EDU>] 
> Sent: Tuesday, April 18, 2017 7:48 AM
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG <mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> Subject: [IMPROVEDX] Intellectual humility
>  
> I just wrote a blog post based on a fascinating article about intellectual humility.  In it I suggest that this trait could help us minimize some diagnostic errors.  I would love the group’s comments:
>  
> A personality trait that may help us minimize diagnostic errors
> http://medrants.com/archives/8695 <http://medrants.com/archives/8695>
>  
> ======================
> Robert M Centor, MD, MACP
>  
> Chair-Emeritus, ACP Board of Regents
>  
> Professor, General Internal Medicine
> UAB
> FOT 720
> 1530 3rd Ave S
> Birmingham, AL 35294-3407
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> Phone: 205-934-7997
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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