A Talk by
                                       Chris Nickson




                                     All
                                   Doctors
                                     Are
                                  Jackasses
Photo	
  by	
  Publicenergy	
  
WHAT DO I
 MEAN ?
BLINDSPOT
   BIAS



            Photo	
  by	
  Zanthia	
  
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               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	
  
Photo	
  by	
  Loupe	
  Clean	
  




How they interact
Photo	
  by	
  Loupe	
  Clean	
  




COGN
     ITVE
 MISE
      R
Photo	
  by	
  Loupe	
  Clean	
  




RELEGAT
       I ON
Photo	
  by	
  Loupe	
  Clean	
  




OVER RIDE
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
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
                                             ain’t so bad… At
                                              least I’m 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	
  




Photo	
  by	
  Kugel	
  
FINALLY…

  What you
need to do now	
  
Think
Learn
Talk
  Do	
  
The End!




           Photo	
  by	
  asibiri	
  

All Doctors Are Jackasses