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Photo by Publicenergy

Photo by Publicenergy A Talk by Chris Nickson All Doctors Are Jackasses

A Talk by

Chris Nickson

All Doctors Are Jackasses
All
Doctors
Are
Jackasses

WHAT DO I MEAN ?

BLINDSPOT BIAS
BLINDSPOT
BIAS

Photo by Zanthia

Photo by Zanthia

Photo by Zanthia

Photo by Zanthia

What? Me A Jackass?
What?
Me
A Jackass?

The dual process model

From: Croskerry P. Healthc Q. 2009 PMID: 19667765.

PATIENT PRESENTATION Pattern PROCESSOR recognised NOT recognised SYSTEM SYSTEM TWO ONE
PATIENT
PRESENTATION
Pattern
PROCESSOR
recognised
NOT recognised
SYSTEM
SYSTEM
TWO
ONE

Photo from Star Trek

Reason? Probability? WTF?!
Reason?
Probability?
WTF?!
Photo from Star Trek Reason? Probability? WTF?! SYSTEM ONE

SYSTEM

ONE

Captain Kirk is in charge? That’s illogical!
Captain Kirk is
in charge?
That’s illogical!

SYSTEM

TWO

Photo from Star Trek

Photo by Loupe Clean How they interact

Photo by Loupe Clean

How they interact
How they interact

Photo by Loupe Clean

COGNITVE MISER
COGNITVE
MISER

Photo by Loupe Clean

RELEGATION
RELEGATION

Photo by Loupe Clean

OVER RIDE
OVER RIDE

Don’t

forget

AAA!

Loin pain + haematuria = RENAL COLIC
Loin pain +
haematuria =
RENAL
COLIC

Photos from Star Trek

That’s not a good idea Jim
That’s not a
good idea
Jim
Set phasers on STUN!
Set
phasers
on STUN!

Photos from Star Trek

Photo by Charles Fred

Off to work we go
Off to work
we go
Is the Well’s Score 0 or +3?
Is the Well’s
Score 0 or +3?

ENTER THE COGNITIVE MINEFIELD

Photo by Defence Images

Not too tight… OUCH!
Not too
tight…
OUCH!

Photo courtesy of Cliff Reid

MEET THE PATIENT

Photo courtesy of Cliff Reid

I’m starving!
I’m
starving!
Could it be acute coronary syndrome?
Could it be
acute
coronary
syndrome?

Photo from Dr Strangelove

Perhaps if the D-dimer is negative…
Perhaps if
the D-dimer
is negative…
I said “NO CHEESE”!
I said “NO
CHEESE”!

Photo courtesy of Cliff Reid

I’m NOT laughing… My chest HURTS!
I’m NOT
laughing…
My chest
HURTS!

Photo courtesy of Cliff Reid

hNp:// lifeinthefastlane.com/ ecg -library/anterior- stemi /
hNp:// lifeinthefastlane.com/ ecg -library/anterior- stemi /
hNp:// lifeinthefastlane.com/ ecg -library/anterior- stemi /
hNp:// lifeinthefastlane.com/ ecg -library/anterior- stemi /
hNp:// lifeinthefastlane.com/ ecg -library/anterior- stemi /
hNp:// lifeinthefastlane.com/ ecg -library/anterior- stemi /

hNp:// lifeinthefastlane.com/ ecg-library/anterior- stemi /

Photo from Wikipedia

CABG then OFF WE GO TO THE ICU

hNp:// lifeinthefastlane.com/2010/04/to-err-is-human-002/

What were they thinking?
What were
they
thinking?

Photo by Klearchos Kapoutsis

1

Over-attachment to a particular diagnosis

Photo by visualpanic

Anchoring confirmation bias premature closure

Photo by visualpanic

2

Failure to consider alternative diagnoses

Photo by Darwin Bell

SEARCH SATISFICING SUTTON’s slip
SEARCH SATISFICING
SUTTON’s slip

Photo by Darwin Bell

3

Inheriting someone else s thinking

Photo by just.Luc

DIAGNOSTIC MOMENTUM FRAMING EFFECT
DIAGNOSTIC MOMENTUM
FRAMING EFFECT

Photo by just.Luc

4

prevalence perception or estimation

Photo by Darwin Bell

AVAILABILITY BIAS BASE RATE NEGLECT
AVAILABILITY BIAS
BASE RATE NEGLECT

Photo by Darwin Bell

5

patient characteristics or presentation context

NEGATIVE STEREOTYPING TRIAGE CUEING
NEGATIVE STEREOTYPING
TRIAGE CUEING

6

physician affect, personality or decision style

Photo by Tal Bright

UNDERCONFIDENCE VISCERAL BIAS
UNDERCONFIDENCE
VISCERAL BIAS

Photo by Tal Bright

Only a JACKASS would do that job!
Only a
JACKASS
would do that
job!

UNUSUAL

DEMANDS

Image by Nasa Goddard Photo and Video

A PERFECT STORM

Being a Jackass ain’t so bad… At least I’m not a doctor!
Being a Jackass
ain’t so bad… At
least I’m not a
doctor!

Photo by The Flying Gerbil

Can we think better ?

HOW we CAN think better

Metacognition Image from: hNp:// www.usask.ca /educa]on/coursework/802papers/Adkins/SEC1.HTM
Metacognition
Metacognition

Image from: hNp:// www.usask.ca /educa]on/coursework/802papers/Adkins/SEC1.HTM

USE cognitive checkpoints
USE
cognitive
checkpoints
USE cognitive checkpoints

REDUCE

Cognitive

load

REDUCE Cognitive load

Turn experience into expertise

think critically

think

critically

OPTIMISE work conditions

Photo by Kugel

look after yourself

FINALLY

What you need to do now

Think Learn Talk Do
Think Learn Talk Do
Think
Learn
Talk
Do
Think Learn Talk Do
The End!
The End!
The End! Photo by asibiri

Photo by asibiri