Photo by Publicenergy
A Talk by Chris Nickson
All
Doctors
Are
Jackasses
WHAT DO I
MEAN ?
Photo by Zanthia
BLINDSPOT
BIAS
Photo by Zanthia
Photo by Zanthia
What? Me..
A Jackass?
The
dual process
model
From: Croskerry P. Healthc Q. 2009 PMID: 19667765.
PATIENT
PRESENTATION
Pattern
PROCESSOR
SYSTEM
ONE
SYSTEM
TWO
recognised NOT recognised
SYSTEM
ONE
Photo from Star Trek
Reason? Probability?
WTF?!
SYSTEM
TWO
Photo from Star Trek
Captain Kirk is in charge?
That’s illogical!
Photo by Loupe Clean
How they interact
Photo by Loupe Clean
COGNITVE MISER
Photo by Loupe Clean
RELEGATION
Photo by Loupe Clean
OVER RIDE
Photos from Star Trek
Loin pain + haematuria =
RENAL COLIC
Don’t forget AAA!
Photos from Star Trek
That’s not a good idea
Jim..
Set phasers
on STUN!
Photo by Charles Fred
Off to work we go..
Photo by Defence Images
ENTER THE
COGNITIVE
MINEFIELD
Is the Well’s Score 0 or +3?
Not too tight… OUCH!
MEET THE
PATIENT
Photo courtesy of Cliff Reid
Photo courtesy of Cliff Reid
I’m starving!
Photo from Dr Strangelove
Could it be acute
coronary syndrome?
Perhaps if the D-dimer is negative…
I said “NO CHEESE”!
Photo courtesy of Cliff Reid
Photo courtesy of Cliff Reid
I’m NOT laughing… My chest HURTS!
hNp://lifeinthefastlane.com/ecg-‐library/anterior-‐stemi/
CABG then OFF WE GO
TO THE ICU
Photo from Wikipedia
hNp://lifeinthefastlane.com/2010/04/to-‐err-‐is-‐human-‐002/
Photo by Klearchos Kapoutsis
What were they
thinking?
Over-attachment
to a particular diagnosis
Photo by visualpanic
1
Anchoring
confirmation bias
premature closure
Photo by visualpanic
Failure to consider
alternative diagnoses
Photo by Darwin Bell
2
SEARCH SATISFICING
SUTTON’s slip
Photo by Darwin Bell
Inheriting someone else’s
thinking
Photo by just.Luc
3
DIAGNOSTIC MOMENTUM
FRAMING EFFECT
Photo by just.Luc
prevalence perception
or estimation
Photo by Darwin Bell
4
AVAILABILITY BIAS
BASE RATE NEGLECT
Photo by Darwin Bell
patient characteristics
or presentation context
5
NEGATIVE STEREOTYPING
TRIAGE CUEING
physician affect, personality or
decision style
Photo by Tal Bright
6
UNDERCONFIDENCE
VISCERAL BIAS
Photo by Tal Bright
Photo from Apollo 13
UNUSUAL
DEMANDS
Only a JACKASS
would do that job!
Image by Nasa Goddard Photo and Video
A PERFECT
STORM
Photo by The Flying Gerbil
Being a Jackass ain’t so bad… At least I’m not a
doctor!
Can we think
better ?
HOW we CAN
think better
Metacognition
Image from: hNp://www.usask.ca/educa]on/coursework/802papers/Adkins/SEC1.HTM
USE
cognitive
checkpoints
REDUCE
Cognitive
load
Turn experience
into expertise
think
critically
OPTIMISE work conditions
look after
yourself
Photo by Kugel
FINALLY…
What you
need to do now
Think
Learn
Talk
Do
Photo by asibiri
The End!