All Doctors Are Jackasses

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

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RELEGATION

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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

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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!