Risky decision-making

I am back in London for a short stay to attend a conference entitled Risky Business, organized by Great Ormond Street Hospital for Children, the National Health Service, and BMJ Group. Allan Goldman, the conference director, says:

The aim of this conference is to hear from some of the highest achievers in other high risk industries on the topics of risk, human factors, patient safety, teamwork, leadership, and improvement.

The presentations have been among the best I have heard anywhere. There are several I would summarize, but for now, please consider watching this one by Pat Croskerry, Professor in Emergency Medicine at Dalhousie University, Halifax, Nova Scotia.



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.

Why is it addictive? Croskerry describes the "cognitive miser function," a tendency to get comfortable with the form of decision-making that you find most used and useful.

The problem, of course, is that the overall rate of diagnostic failure is about 15%, and most of those diagnoses are made based on the intuitive approach. Not that the analytic approach is always correct, either. Indeed, in studies of factors contributing to failures to diagnose, cognitive errors alone or in part account for about 75% of the cases.

Croskerry thinks we need to spend more time teaching clinicians to be more aware of the importance of decision-making as a discipline. He feels we should train people about the various forms of cognitive bias, and also affective bias. Given the extent to which intuitive decision-making will continue to be used, let's recognize that and improve our ability to carry out that approach by improving feedback, imposing circuit breakers, acknowledging the role of emotions, and the like.

While you are at it, check out the video of this presentation by Duncan Murrell, who employs intuitive decision-making while photographing humpback whales -- sometimes in the middle of a feeding frenzy -- from a kayak in Southeast Alaska. (You can see the photographs up close here.)

If you can't see the videos, click here.