The September 15, 2010 issue of the Journal of the American Medical Association contains “Clinician’s Corner” articles about placing patient treatment in their personal context, being biased in favor of diagnosing diseases you saw most recently, and becoming predisposed to accept gifts from the medical industry. The lessons from these studies have broad application to our conduct, beyond just the members of the medical profession.           

 

1.         Contextualized Patient Care

            Doctors assess and manage patients based on their medical knowledge base.  The more they learn about the care recipient’s individual situation, the more it ends up being a part of the treatment plan. Schwartz, A Weiner S, et al. An Educational Intervention for Contextualizing Patient Care and Medical Students’ Abilities to Probe for Contextual Issue in Simulated Patients. JAMA 2010; 304(11): 1191-1197.

            Outside the medical domain, we would call this information management, pattern recognition and objective reflective reasoning. Essentially, the more we learn about a situation, the better equipped we are to deal with it. Knowledge matters; but as the next section demonstrates, it needs to be the right knowledge.
 

2.         Availability Bias 

            Recent treatment experience with a particular diagnosis increased the likelihood that 1st and 2nd year medical residents would rely on it again, even if it was inapplicable. These fast, intuitive decisional errors based on pattern recognition, which are perhaps more frequently made by experts, are called “non-analytical reasoning”. The interns who had not encountered a similar medical case recently did not display the same tendency to wrongly apply diagnoses to new cases. They were utilizing what is called “reflective reasoning”. Mamede S, van Gog T, et al. Effect of Availability Bias and Reflective Reasoning on Diagnostic Accuracy Among Internal Medicine Residents. Id.,1198-1203.

            In my opinion, this distinction between quick and wrong decision-making, and choices that are more probative and thoughtful, appears throughout all walks of life: 

 

Problem

Non-analytical Solutions

Reflective Solutions

A. Marital difficulties such as loss of romantic interest or joint problem-solving ability, cruelty, spousal abuse.

Adultery, separation, divorce.

Improved communication, stress management, financial planning, boundary preservation, conflict resolution tools, mutual respect.

B. Economic crisis, like unemployment or the inability to pay all bills on time.

Replace elected representative, oppose any new taxes (even on the rich), demonstrate against Government spending cuts (e.g. students in the U.K. and Italy; and French workers opposing an increase in the retirement age.

Raise taxes (increase income). Cut spending.

C. Fear of terrorists.

Jersey walls and full-body airport scans.

 

 

Qualitative threat-assessment heuristics such as those utilized to evaluate passengers on EL AL, the Israeli airline.  Express-lane passes for pre-qualified categories of people, like the attorney-ID’s at the Fairfax County (Virginia) Judicial Center.

       

 

3.         Gift Rationalization

                        A number of behavioral economics studies have recently shown that people approaching a decision are unconsciously influenced by a subtly suggested mind-set. This “post hoc ergo propter hoc” fallacy applies to doctors: Resident physicians “primed” with a perception that they were underpaid, significantly indebted, and generous in their career sacrifices were more likely to accept gifts from industry.

            The faulty logic underlying this behavior applies equally well to voters susceptible to simplistic conditioning:

            >    No new taxes;

            >    Less government without cutting the military budget or entitlements;

            > Others are responsible for everything wrong; and

            > Sarah Palin’s predicted 2012 campaign theme, American exceptionalism.

 

            This logical trap might ensnare any of us. A possible example is Mr. Murray Hardison Wright, who in April of this year filed a motion to reduce the monthly alimony he had been paying his ex since 1992. Wright v. Wright, CL 09-4587-01, Circuit Court for the City of Richmond, Virginia, Opinion and Order of September 1, 2010, p.7. Mr. Wright argued that “Mrs. Wright should work as a nurse, despite the fact that she last worked in 1978, has had three heart attacks, and wears a heart monitor. Needless to say, the judge did not require she return to employment.