FW: Cognitive Biases and the Human Brain - The Atlantic

Tom Benzoni benzonit at GMAIL.COM
Mon Aug 6 15:04:33 UTC 2018


Thanks for the article; it precisely captures an n=1 study in which I was a
participant

As a patient, I recently attended a very prestigious medical institute for
personal care.
During my inaugural visit, the place was using a homegrown suite of
software programs.
The software communicated as needed; I went to various places on campus and
my data followed and was updated.
Staff was attuned to me and served my needs and, I presume, my physician's.
(Kind of unique idea, making us the same unit of service...)
There were several visits.

Recently, this place bought a software suite that would replace all its
homegrown solutions.
Spent a lot of money; more than I've ever seen. Or ever will see.
But It was all for the good...until I went for another visit.

The software was now well-entrenched, and the employees couldn't see me.
They reminded of my kids at the mall: walking with their friends, ignoring
them while they text someone else.
The employees were doing as directed, serving the Machine.
The physicians were not being served; lacking a "No" card so could just
buckle under.
The entire place's culture was changed.

Personally, I am fine; my health problem was dealt with under the old
system.
But to see such a remarkable transformation of this institution was
disheartening.
Physicians and staff were being diverted from their most important task (in
my eyes,) which is ME!

I'm no technophobe: FORTRAN programmer, Linux, network admin and ER Doc,
trained on 2 major and 3 smaller systems.
What I saw makes me concerned that we're not talking about the culture
change that has happened, who is the new God being served.
It's not the patient.

Oh, and to make matters worse: the decision makers and beneficiaries of
these system changes do not earn any of the money that permits their
purchase.
It's Socrates, mixing his own hemlock.

tom benzoni



On Mon, Aug 6, 2018 at 9:42 AM Bruno, Michael <
mbruno at pennstatehealth.psu.edu> wrote:

> 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,
>
>
>
> *[image: 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
> ( (717) 531-8703  |  6 (717) 531-5737
>
> *** mbruno at pennstatehealth.psu.edu  |
> [image: inspired to keep patient safe]
>
>
>
> *****E-Mail Confidentiality Notice*****
> This message (including any attachments) contains information intended for
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>
>
>
>
> *From:* Swerlick, Robert A [mailto:rswerli at EMORY.EDU]
> *Sent:* Sunday, August 05, 2018 3:44 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *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
>
> 404-727-3669
>
>
>
>
> ------------------------------
>
> *From:* Pat Croskerry <croskerry at EASTLINK.CA>
> *Sent:* Sunday, August 5, 2018 11:50:39 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *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
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* [IMPROVEDX] FW: Cognitive Biases and the Human Brain - The
> Atlantic
>
>
>
> Thanks to Eta Berner for this …..
>
>
>
> https://www.theatlantic.com/magazine/archive/2018/09/cognitive-bias/565775/
>
>
>
>
>
>
>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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