Kahneman interview

Edward Winslow edbjwinslow at GMAIL.COM
Mon Feb 4 15:53:58 UTC 2019


Gentlemen,

I think that this thread has the potential to be tremendously important.
There are multiple contributors to the diagnostic process, many of which
are in the recent pub that SIDM contributed to.  Recently we've seemed to
become more focused on the weeds, not the forest. Getting back to how we
look at the diagnostic cascade  may help us. Certainly, thinking about
thinking is important. Pat C. has been a leader in thinking about how we
process information. I would love to take his course :-). I'd like to
propose some thoughts on the Diagnostic Process, including getting back to
basics, the place of the differential diagnosis, and use of second opinions
(including disease

When I began, in Canada, almost every medical student had the University of
Toronto, pocket book on History and Physical. The process for approaching
the diagnosis of patient complaints was laid out as a precursor of a "check
list".  (When I was a student there were almost no "preventive therapies".
Screening for cancers was in its infancy - so things were simpler. All we
had to do was evaluate symptoms and try to come up with a diagnosis.).

In those days, we recognized something about the "Anchoring Bias" (AB),
though we didn't call it that. The  "Differential Diagnosis" (subsequently
called "Rule Outs", of "Also Consider's", among other things) was an
attempt at forcing ourselves not to succumb to the AB).

Kahneman's tome is an interesting read, that I found illuminating, but
difficult. I might suggest that most of us consider reading either the
book, "Thinking Fast and Slow", itself or one of the several fairly good
summaries.

Certainly, one of the great tools, to help us account for the AB, is the
second opinion. Like Xavier, and others who comment in these threads, I
regularly encouraged second opinions. Usually, however, these weren't for
diagnostic dilemmas, but for therapeutic challenges - weighing benefits and
harms or treatments. We might be well served by using another pair of ears
and eyes on our diagnoses too - a second opinion. The story in Groopman's,
"How Doctors Think" may reinforce this concept.

There are many impediments to using the Diagnostic Process to its full, in
today's climate. Hopefully, SIDM will help us overcome some of them.

On Sun, Feb 3, 2019 at 5:51 PM Xavier Prida <dr.xavier.prida at gmail.com>
wrote:

> Art,
>           I second your advocacy for second reads and co-decision making.
> And, I like you was surprised by his stated futility to become de-biased.
> That is where his remedy of "thinking again" has play.
> As a cardiologist involved in team deliberations(Heart Valve Team, Heart
> Revascularization Team) second and third reads are embedded with "wisdom of
> the cloud" final disposition. As stated by Mrs. Meers- "It's so sad to be
> all alone in the world"- and, dangerous in medicine.
>
> Regards,    Xavier
>
>
> * 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)
> 813 831 0721(H)
> 813 245 3143(C)
>
>
> On Sun, Feb 3, 2019 at 2:33 PM Art Papier <apapier at visualdx.com> wrote:
>
>> Thanks for sharing!   Great interview with many fascinating threads, and
>> some new thoughts on the randomness of error, and how all error is not due
>> to cognitive bias.  Towards the conclusion we hear that Dr. Kahneman in not
>> a believer in cognitive debiasing…. saying essentially we are too busy
>> making errors to recognize that we are making errors.  He asserts we should
>> be thinking about how we recognize other peoples errors.  In made me think
>> of the session at DEM on perceptual errors in diagnostic imaging and the
>> very positive role of second reads in radiology….whether by humans or AI to
>> recognize errors.  Perhaps either co-decision making, or AI “second
>> opinions” is an area we should all be further exploring.
>>
>> Best
>>
>> Art
>>
>>
>>
>> Art Papier MD
>>
>> CEO VisualDx
>>
>> Associate Professor of Dermatology and Medical Informatics
>>
>> University of Rochester College of Medicine
>>
>>
>>
>> *From:* Xavier Prida <dr.xavier.prida at GMAIL.COM>
>> *Sent:* Sunday, February 03, 2019 8:59 AM
>> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> *Subject:* [IMPROVEDX] Kahneman interview
>>
>>
>>
>> On "thinking again"- not changing your mind, error, and bias - the latter
>> two are not always linked.
>>
>>
>>
>>
>> https://onbeing.org/programs/daniel-kahneman-why-we-contradict-ourselves-and-confound-each-other-jan2019/
>>
>>
>>
>> XEP
>>
>>
>>
>>  *praesent superare odio  **(rise 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)
>>
>>
>>
>>
>> ------------------------------
>>
>>
>>
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>>
>>
>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>>
>
> ------------------------------
>
>
> To unsubscribe from IMPROVEDX: click the following link:
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> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/



-- 
*Edward B, J. Winslow, MD, MBA*
Home 847 256-2475; Mobile 847 508-1442
edbjwinslow at gmail.com
winslowmedical.com


*“...the more you know about the past, the better you are prepared for the
future.” *

Theodore Roosevelt, 26th President of United States of America






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


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