A Talk by Chris Nickson

All Doctors Are Jackasses

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WHAT DO I MEAN ?

BLINDSPOT BIAS

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Photo by Zanthia

What? Me.. A Jackass?

Photo by Zanthia

The dual process model

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

PATIENT PRESENTATION

Pattern PROCESSOR
recognised NOT recognised

SYSTEM ONE

SYSTEM TWO

Reason? Probability? WTF?!

SYSTEM ONE
Photo from Star Trek

Captain Kirk is in charge? Thats illogical!

SYSTEM TWO
Photo from Star Trek

Photo by Loupe Clean

How they interact

Photo by Loupe Clean

COGN ITVE MISE R

Photo by Loupe Clean

RELEGAT I ON

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OVER RIDE

Dont forget AAA!

Loin pain + haematuria = RENAL COLIC

Photos from Star Trek

Thats not a good idea Jim..

Set phasers on STUN!

Photos from Star Trek

Off to work we go..

Photo by Charles Fred

Is the Wells Score 0 or +3?

ENTER THE COGNITIVE MINEFIELD

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Not too tight OUCH!

MEET THE PATIENT

Photo courtesy of Cli Reid

Im starving!

Photo courtesy of Cli Reid

Could it be acute coronary syndrome?

Perhaps if the D-dimer is negative

Photo from Dr Strangelove

I said NO CHEESE!

Photo courtesy of Cli Reid

Im NOT laughing My chest HURTS!

Photo courtesy of Cli Reid

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?

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Over-attachment to a particular diagnosis

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Anchoring confirmation bias premature closure

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2
Failure to consider alternative diagnoses

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SEARCH SATISFICING SUTTONs slip

Photo by Darwin Bell

3
Inheriting someone elses thinking

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DIAGNOSTIC MOMENTUM FRAMING EFFECT

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prevalence perception or estimation

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AVAILABILITY BIAS BASE RATE NEGLECT

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5
patient characteristics or presentation context

NEGATIVE STEREOTYPING TRIAGE CUEING

6
physician affect, personality or decision style

Photo by Tal Bright

UNDERCONFIDENCE VISCERAL BIAS

Photo by Tal Bright

Only a JACKASS would do that job!

UNUSUAL DEMANDS

Photo from Apollo 13

Image by Nasa Goddard Photo and Video

A PERFECT STORM

Being a Jackass aint so bad At least Im 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

USE cognitive checkpoints

REDUCE Cognitive load

Turn experience into expertise

think critically

OPTIMISE work conditions

look after yourself

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FINALLY What you need to do now

Think Learn Talk Do

The End!

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