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This months topic is thinking. Yes, thinking. We do it automatically (well, most of us do) let’s face it, there are times when our brains are on auto pilot. In medicine, with experience we hit a phase known as unconscious competence. Where we know what do to and we don’t have to go to what Daniel Kannehamn calls “system 2 thinking.” System 1 thinking is answering a question like “do you like the movie Forest Gump” or “is it cold in this room?” They are visceral questions. No pondering needed. But, if I ask what is 13 x 17? We have to shift our thinking into level 2 thinking. More energy is needed. A different mechanism.

In teaching on medical errors for the last ten years, I have learned there are a number of thinking errors that are well defined and are traps we fall into. Now the beauty of defining the traps means we are better able to acknowledge them when they are happening and not succumb to it. I can’t stress this enough folks… this new focus on thinking changed my life. It changed how I practice medicine, but more then that… it changed how I think on a daily basis.

Great wisdom literature states we are not our thoughts. We are the conscious awareness of our thoughts. When I can think about my thinking, then I am connecting to a much deeper experience. I know I may have lost a few of you right now. I know a few of you are thinking this is getting too “out of this world” yoga/meditation far fetched. Bear with me for a second and let me ask you a question.

A real question. When it comes to you life and practice of medicine, do you want optimal thinking? Do you want to make wise decisions and thinking logically? This sounds a bit silly. I get it. But… When you evaluate a person with back pain that’s allergic to NSAIDS, do you want a clear and unbiased mind to think objectively, rationally and logically or do you want to be emotional and biased? Do you get drawn into making emotional decisions based on a gut reaction?

That called the affect heuristic. It is a type of heuristic in which emotional response, or “affect” in psychological terms, plays a lead role. We get a guy reaction and use that gut reaction to drive decisions. I admit I have fallen pray to this. A lot. Allowing a gut reaction to drive a number of decisions surrounding that reaction. It’s served me well in life, at times, yet at times, especially when good medicine mandates optimal thinking, I have fallen short.

Herbert Spencer says, “There is a principle which is a bar against all information, which is proof against all arguments, and which cannot fail to keep a man in everlasting ignorance—that principle is contempt (anger and disgust) prior to investigation.” I find that when I like a patient too much, or dislike a patient too much, I am opening myself to the affect heuristic.

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Robert

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