Today’s post on Paul Levy’s blog led me back to this November post, where he posted this 35 minute lecture. I was going to write about the subject, embedding this at the end, but you have to absorb this first. Clinicians and patients alike, please watch.
I think if we want to improve this aspect of medicine, it’s essential to understand the evidence presented here. It documents some of the major challenges in diagnosis, which suggest that we shouldn’t expect clinicians to be perfect and clinicians shouldn’t expect us to think they are.
The lecturer is Pat Croskerry, Professor in Emergency Medicine at Dalhousie University, Halifax, Nova Scotia. Levy’s post says:
Croskerry’s exposition compares intuitive versus rational (or analytic) decision-making. Intuitive decision-making is used more often. It is fast, compelling, requires minimal cognitive effort, addictive, and mainly serves us well. It can also be catastrophic in that it leads to diagnostic anchoring that is not based on true underlying factors.
He says we should explicitly teach decision making skills in medical training. I’ll add: if we all recognize the difficulty of perfect decisions, we can work together to improve the odds – with more participation, less blaming, and overall better outcomes. And, I hope, less unwarranted stress for clinicians who are doing the best they can.