Kahneman interview

Jason Maude jason.maude at ISABELHEALTHCARE.COM
Tue Feb 5 16:31:36 UTC 2019


If you have time to ask for a 2nd opinion for diagnosis, rather than therapy, then surely it makes more sense to compile a DDx which can be done in seconds using a DDx Generator. The problem with a 2nd opinion is that it may help but could also help you just remain more convinced of a wrong diagnosis!

An effective RCT study carried by Rosalind Franklin Medical School in Chicago highlighted this problem when they compared one lot of students consulting their Resident and the other group using a DDx Generator https://www.isabelhealthcare.com/pdf/collaboration_poster_AAMC_5-28-13.pdf

The compilation of a DDx seems a practical trigger to stop and think. As a trigger, it could be required for every patient (my preference) or instead required when triggers are set off for events such as a patient returning for the same problem within 48 hours or no diagnosis 48 hours after admission.

Regards
Jason

Jason Maude
Founder and CEO Isabel Healthcare
Tel: +44 1428 644886
Tel: +1 703 879 1890
www.isabelhealthcare.com<http://www.isabelhealthcare.com/>


From: Edward Winslow <edbjwinslow at GMAIL.COM>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Edward Winslow <edbjwinslow at GMAIL.COM>
Date: Monday, 4 February 2019 at 16:15
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] Kahneman interview

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<mailto: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  (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)
813 831 0721(H)
813 245 3143(C)


On Sun, Feb 3, 2019 at 2:33 PM Art Papier <apapier at visualdx.com<mailto: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<mailto:dr.xavier.prida at GMAIL.COM>>
Sent: Sunday, February 03, 2019 8:59 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto: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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