FW: Cognitive Biases and the Human Brain - The Atlantic

Bruno, Michael mbruno at PENNSTATEHEALTH.PSU.EDU
Mon Aug 6 14:08:10 UTC 2018

Very insightful of Upton Sinclair, and of you too, Dr. Swerlick!

We've created healthcare systems that do exactly what they were designed to do: maximize revenue.  And they do it quite well, and despite a challenging economic environment in healthcare.  The tradeoff for this very tangible benefit is high levels of physician burnout, a poor patient experience, and sub-optimal quality and safety in patient care.  If we want our healthcare systems to do other things instead, such as provide excellent healthcare to patients, or if we perhaps want our systems to become the kind of working environment that does not produce physician burnout on a massive scale, then we will need to fundamentally redesign them.

It is the same reasoning that has been applied to the electronic medical record (see the attached article).

All the best,

[cid:image004.png at 01D112FF.F77F98B0]
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
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[inspired to keep patient safe]

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From: Swerlick, Robert A [mailto:rswerli at EMORY.EDU]
Sent: Sunday, August 05, 2018 3:44 PM
Subject: Re: [IMPROVEDX] FW: Cognitive Biases and the Human Brain - The Atlantic

The skepticism regarding de-biasing is not a either it works or doesn't. It may work in specific circumstances with specific populations. In healthcare delivery, the question is where are those circumstances where training people results is meaningful return on investment and where are the circumstances where the environment (system issues) are so overwhelming that it does not make sense to try to de-bias those who embedded in such systems.

The environments I observe are volume driven and financially reward heavy dependence on system one engagement. De-biasing will almost certainly require engagement of system 2 translating to less volume less volume and fewer $'s. Unless there are meaningful changes in how we reward practice activities, this will be a hard sell. I can't help but recall a quote from Upton SInclair:

"It is difficult to get a man to understand something, when his salary depends on his not understanding it."
― Upton Sinclair<https://www.goodreads.com/author/show/23510.Upton_Sinclair>, I, Candidate for Governor: And How I Got Licked<https://www.goodreads.com/work/quotes/254630>

Robert A. Swerlick, MD
Alicia Leizman Stonecipher Chair of Dermatology
Professor and Chairman, Department of Dermatology
Emory University School of Medicine

From: Pat Croskerry <croskerry at EASTLINK.CA>
Sent: Sunday, August 5, 2018 11:50:39 AM
Subject: Re: [IMPROVEDX] FW: Cognitive Biases and the Human Brain - The Atlantic

Thanks for the link.

Evidence that the pessimism about bias mitigation is unwarranted is accumulating. Nobody said it would be easy, but nobody should say it can't be done.

Nisbett's work is acknowledged in this piece - his recent book describes a number of strategies: Mindware: Tools for Smart Thinking .

Further, a recent review in Medical Decision Making found that most of 74 interventions in 13 studies were effective:

(Ludolph R, Schulz PJ. Debiasing health-related judgments and decision making: A systematic review. Medical Decision Making 2017; 38 3-13).

From: mgraber <graber.mark at GMAIL.COM>
Sent: August 5, 2018 11:25 AM
Subject: [IMPROVEDX] FW: Cognitive Biases and the Human Brain - The Atlantic

Thanks to Eta Berner for this .....


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

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