Sunday, 25 August 2013

From Mindless to Mindful Practice – Cognitive Bias and Clinical Decision Making

Our brains tend to process and manage information either "intuitively" or "analytically". Intuitive thinking is fast, is based on experience and common sense, and is usually right, while analytical thinking is slow, thorough and ensures that we use all our available deductive powers and resources and don't miss things. Analytical thinking (eg thorough use of algorithms, checklists etc) usually results in fewer mistakes or oversights, but is time consuming and simply not practical when dealing with the many decisions required in our daily activities. The problem in medicine is that intuitive thinking (something many experienced clinicians are often proud of) accounts for most of the major clinical mistakes. How then do we balance our use of both thought processes to deal efficiently with the many clinical problems we face every day without exposing patients to unnecessary risks by mentally "cutting corners"? This editorial looks at this question and has enough in it to give us all reason to think about it.

PM

3 comments:

  1. The problem for most of my anesthesia colleagues (& their patients) is a failure of vision...

    If you fail to measure the organ we medicate (i.e. the cerebral cortex), you are already doomed to over-medicate your patients.

    If you fail to trend EMG as a secondary trace to BIS, you fail to have a real time monitor.

    If you fail to respond to EMG spikes as if they were HR or BP changes, you fail to optimize the use of the BIS.

    If you fail to prevent the signal of initial breach of the integument (i.e. skin incision or local anesthetic injection), all your anesthetic is doing is enabling your surgeon to inflict pain upon an unconscious patient whom you have rendered incapable of responding.

    Over the past 15 years & >3,000 BIS/EMG propofol ketamine patients, none has required postop opioid rx. while posting the lowest PONV rate in a high risk group s anti-emetics.

    If you insist on giving opioids +/or stinky gases, you continue to dare the patient to have PONV.

    Most tragically, our colleagues have too often relegated my work to cosmetic surgery, not 'real' surgery.

    Please consider listening to board certified, orthopedic anesthesiologist, Dr. Parson's comments... http://www.youtube.com/watch?v=r6O-stIHlgo&list=TL8XOq1r9QY4Y

    Aside from natural body orifice procedures, ALL surgery involves breaching the barrier between the world of danger & the protected world of self.

    Friedberg's Triad: Measure the brain... preempt the pain... emetic drugs abstain.

    Numerically reproducible outcomes for those who choose to open their minds.

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  2. Please relate your comment to the blog post, lest it seem like irrelevant self-promotion (spam, even).

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  3. Roger... your practice is mindless.
    Is that enough to the point?

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