FW: Cognitive Biases and the Human Brain - The Atlantic

Xavier Prida dr.xavier.prida at GMAIL.COM
Mon Aug 6 16:29:56 UTC 2018


The traditional mantra in QI- "Your outcome(s) is precisely predicated on
your processes " satisfies this. Rather than looking back and recognizing
this epoch as the "information and evidence age of medicine", it shall be
remembered as the economic and business model age. And, it mirrors the
capitalist model with many causalties along the way(patients, physicians,
systems and communities of care disrupted).

And, the most disingenuous part is the corruption of the "triple aim" - the
basis of this is the iron triangle(cost, quality, speed)- extension to the
"quadruple aim" by CMS. An evolved market model is untesed and unproven as
to its ability deliver a quadruple aim.

* praesent superare odio  (r**ise above)*

Xavier E. Prida MD FACC FSCAI
Assistant Professor of Medicine
Program Director Cardiology Fellowship Training
USF Morsani College of Medicine
Department of Cardiovascular Sciences
2 Tampa General Circle
STC 5 th Floor
Tampa, Fl 33606
813 259 0992(O)


On Mon, Aug 6, 2018 at 10:08 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*****
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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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