All Doctors Are Jackasses

•

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Slideshow for the talk I gave at SMACC 2013 titled 'All Doctors Are Jackasses' - see http://lifeinthefastlane.com/2013/03/all-doctors-are-jackasses/ ‎

Gesundheit & Medizin

A Talk by
Chris Nickson

All
Doctors
Are
Jackasses
Photo
by
Publicenergy

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

PATIENT
PRESENTATION

Pattern
PROCESSOR
recognised NOT recognised

SYSTEM SYSTEM
ONE TWO

Reason?
Probability?
WTF?!

SYSTEM
ONE

Photo
from
Star
Trek

Captain Kirk is
in charge?
That’s illogical!

SYSTEM
TWO

Photo
from
Star
Trek

Don’t
forget
AAA!

Loin pain +
haematuria =
RENAL
COLIC

Photos
from

Star
Trek

That’s not a
good idea
Jim..

Set
phasers
on STUN!

Photos
from
Star
Trek

Off to work
we go..

Photo
by
Charles
Fred

Is the Well’s
Score 0 or +3?

ENTER THE
COGNITIVE
MINEFIELD

Photo
by
Defence
Images

Not too
tight…
OUCH!

MEET THE
PATIENT

Photo
courtesy

of
Cliﬀ
Reid

I’m
starving!

Photo
courtesy

of
Cliﬀ
Reid

Could it be
acute
coronary Perhaps if
syndrome? the D-dimer
is negative…

Photo
from
Dr
Strangelove

I said “NO
CHEESE”!

Photo
courtesy

of
Cliﬀ
Reid

I’m NOT
laughing…
My chest
HURTS!

Photo
courtesy

of
Cliﬀ
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?

Photo
by

Klearchos
Kapoutsis

1

Over-attachment
to a particular diagnosis

Photo
by
visualpanic

Anchoring
confirmation bias
premature closure

Photo
by
visualpanic

2

Failure to consider
alternative diagnoses

Photo
by
Darwin
Bell

SEARCH SATISFICING
SUTTON’s slip

Photo
by
Darwin
Bell

3

Inheriting someone else’s
thinking

Photo
by
just.Luc

DIAGNOSTIC MOMENTUM
FRAMING EFFECT

Photo
by
just.Luc

4

prevalence perception
or estimation

Photo
by
Darwin
Bell

AVAILABILITY BIAS
BASE RATE NEGLECT

Photo
by
Darwin
Bell

5

patient characteristics
or presentation context

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
ain’t so bad… At
least I’m not a
doctor!

Photo
by
The
Flying
Gerbil

Metacognition

Image
from:
hNp://www.usask.ca/educa]on/coursework/802papers/Adkins/SEC1.HTM

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All Doctors Are Jackasses

6. A Talk by Chris Nickson All Doctors Are Jackasses Photo by Publicenergy

7. WHAT DO I MEAN ?

8. BLINDSPOT BIAS Photo by Zanthia

9. Photo by Zanthia

10. What? Me.. A Jackass? Photo by Zanthia

11. The dual process model

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

13. PATIENT PRESENTATION Pattern PROCESSOR recognised NOT recognised SYSTEM SYSTEM ONE TWO

14. Reason? Probability? WTF?! SYSTEM ONE Photo from Star Trek

15. Captain Kirk is in charge? That’s illogical! SYSTEM TWO Photo from Star Trek

16. Photo by Loupe Clean How they interact

17. Photo by Loupe Clean COGN ITVE MISE R

18. Photo by Loupe Clean RELEGAT I ON

19. Photo by Loupe Clean OVER RIDE

20. Don’t forget AAA! Loin pain + haematuria = RENAL COLIC Photos from Star Trek

21. That’s not a good idea Jim.. Set phasers on STUN! Photos from Star Trek

22. Off to work we go.. Photo by Charles Fred

23. Is the Well’s Score 0 or +3? ENTER THE COGNITIVE MINEFIELD Photo by Defence Images

24. Not too tight… OUCH! MEET THE PATIENT Photo courtesy of Cliﬀ Reid

25. I’m starving! Photo courtesy of Cliﬀ Reid

26. Could it be acute coronary Perhaps if syndrome? the D-dimer is negative… Photo from Dr Strangelove

27. I said “NO CHEESE”! Photo courtesy of Cliﬀ Reid

28. I’m NOT laughing… My chest HURTS! Photo courtesy of Cliﬀ Reid

29. hNp://lifeinthefastlane.com/ecg-‐library/anterior-‐stemi/

30. Photo from Wikipedia CABG then OFF WE GO TO THE ICU

31. hNp://lifeinthefastlane.com/2010/04/to-‐err-‐is-‐human-‐002/

32.

33.

34. What were they thinking? Photo by Klearchos Kapoutsis

35.

36. 1 Over-attachment to a particular diagnosis Photo by visualpanic

37. Anchoring confirmation bias premature closure Photo by visualpanic

38. 2 Failure to consider alternative diagnoses Photo by Darwin Bell

39. SEARCH SATISFICING SUTTON’s slip Photo by Darwin Bell

40. 3 Inheriting someone else’s thinking Photo by just.Luc

41. DIAGNOSTIC MOMENTUM FRAMING EFFECT Photo by just.Luc

42. 4 prevalence perception or estimation Photo by Darwin Bell

43. AVAILABILITY BIAS BASE RATE NEGLECT Photo by Darwin Bell

44. 5 patient characteristics or presentation context

45. NEGATIVE STEREOTYPING TRIAGE CUEING

46. 6 physician affect, personality or decision style Photo by Tal Bright

47. UNDERCONFIDENCE VISCERAL BIAS Photo by Tal Bright

48. Only a JACKASS would do that job! UNUSUAL DEMANDS Photo from Apollo 13

49. Image by Nasa Goddard Photo and Video A PERFECT STORM

50. Being a Jackass ain’t so bad… At least I’m not a doctor! Photo by The Flying Gerbil

51. Can we think better ?

52.

53. HOW we CAN think better

54. Metacognition Image from: hNp://www.usask.ca/educa]on/coursework/802papers/Adkins/SEC1.HTM

55. USE cognitive checkpoints

56. REDUCE Cognitive load

57. Turn experience into expertise

58. think critically

59. OPTIMISE work conditions

60. look after yourself Photo by Kugel

61. FINALLY… What you need to do now

62. Think Learn Talk Do

63. The End! Photo by asibiri

All Doctors Are Jackasses

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All Doctors Are Jackasses