Medical Decision Making

  • Why are kids dying at the dentist?

    By Marjorie Stiegler on July 21, 2016
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    Is pediatric dental anesthesia safe? Right on the homepage of the ADSA is a big box: “getting sedated at the dentist: there’s nothing to worry about”. Recent news, however, seems to contradict that statement. In Texas alone, there are at least 85 reported deaths of patients who died following dental procedures between 2010 and 2015. In these cases, anesthesia was reportedly administered by dentists with anesthesia training. But what is a 'dentist anesthesiologist'? In the FAQ section of the ADSA website, they state “Anesthesia is administered by a licensed anesthesiologist, who was trained in a formal anesthesia residency program.” No wonder people are confused...
  • Are mentors missing in academic medicine?

    By Marjorie Stiegler on April 26, 2016
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    Are we (the establishment of academic medicine) doing a good job of providing mentorship to the next generation? What is the “path” or “formula” – is there one? Can we improve faculty development for those who have dedicated their professional careers to academic pursuits - those who will make the big discoveries and leaps forward in patient safety and quality healthcare? If you are an academic, I hope you'll...
  • The $500 Popsicle: Perceived Value and Commission Bias

    By Marjorie Stiegler on December 31, 2015
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    A toddler falls face-first onto an iron table, bleeding profusely. Mom takes the baby to the emergency room. After her child was evaluated, it was determined that no serious injury was sustained, no further intervention was needed, and the toddler was discharged home with some wound care instructions and a popsicle. When the mother subsequently received a bill from the ER, she remarked, “That was one pricey popsicle.” But deciding to "do nothing" IS doing something - something that requires a high level of medical expertise...
  • BX2015 Highlights: The 2015 International Behavioural Exchange Conference

    By Marjorie Stiegler on September 6, 2015
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    Did you know? The relentless stress caused by poverty has the same effect as reducing your IQ by about 15 points. And if you look even a little bit poor, you are also perceived as incompetent – so things are only looking worse for you tomorrow. Most people lie and cheat a little; few lie and cheat a lot. Very few people actually steal…unless it’s for a good cause. Want someone to do something for you? Follow this formula...
  • Why Can’t We Fix the Diagnostic Error Epidemic?

    By Marjorie Stiegler on March 9, 2015
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    It is estimated that the volume of knowledge is doubling at least every 8 years. This rate of expansion overwhelms our capacity to stay abreast of emerging knowledge, even in the ever-narrowing micro-specialization of medical practice. New careers are created while other fields die out. Rapid access and effective delivery of information becomes paramount to both patient safety and professional success. It is not surprising, then, that the potential for delayed or incorrect diagnosis exists. Cognitive psychology theory also tells us it is not surprising that modern decision support systems are ineffective are reducing this problem. Why?
  • Can “Doing Everything” Be Cruel to Clinicians?

    By Marjorie Stiegler on February 9, 2015
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    “ 'To any doctor who will take care of me in the future: I want you to do EVERYTHING in your power to keep me alive AS LONG AS YOU POSSIBLY CAN!' And now he was suffering, with every lonely hour in an ICU isolation room...we could keep his body going even while it was trying its hardest to die." This article and associated comments raise many interesting and important questions: Is having to honor such a hopeless patient request "cruel" to the medical professionals who care for him? What is the balance between giving end of life care, and healthcare costs? And this advice to modern-day physicians: "Whether you like it or not, whether it shocks you or not, whether you agree with it or not, your only job is to accommodate the wishes of the patient. In that way you are no different from a car mechanic or a house painter: you are there ONLY to provide the services that your customers request."
  • Never Be Wrong (Or At Least, Catch Yourself Sooner!)

    By Marjorie Stiegler on November 15, 2014
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    My last post discussed how the building blocks of expertise and experience - stored memory collections of events and ideas - are the repository from which we make diagnostic and therapeutic decisions. Now, let’s consider three key strategies that may assist us in counterbalancing availability bias (confusing memorability with probability). This post is intended to address cases in which expert intuition lead us to a cognitive error called “premature closure” – selecting the first plausible diagnosis that comes to mind and seems to match the contextual information. Strategies to prevent premature closure hinge upon...
  • What Makes Us Expert Also Makes Us Error-Prone: The Role of Memory and Cognition in Medical Decisions

    By Marjorie Stiegler on November 3, 2014
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    Are our memories true histories, or just stories? Experience is critical to acquisition of expertise, and yet memories of our experiences are often incomplete and sometimes incorrect. Let’s consider experience, and how the same processes that lead to expertise may also lead to error. (Note: this post is intended to compliment my upcoming lecture at the Stanford University School of Medicine course “Medical Education in the New Millennium” )...
  • Stanford University’s Medical Education in the New Millennium

    By Marjorie Stiegler on October 24, 2014
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    Big news! I've been asked to join the faculty of the Stanford University School of Medicine's course "Medical Education in the New Millennium:Innovation and Digital Disruption." This is a huge honor, of course, because Stanford is really pushing the concept of multidisciplinary and patient centered medical education in an awesome way. Here's a little bit about the course, from the Stanford website: "This interdisciplinary course features talks from thought leaders and innovators from medical education, instructional design, cognitive science, online learning, and emerging technology...
  • Stealing Expertise from K. Anders Ericsson

    By Marjorie Stiegler on September 10, 2014
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    Last week, I had the enormous pleasure of being a keynote speaker at a simulation symposium in Kansas City alongside the very famous Anders Ericsson. If you don’t think you know him, think again. He’s the brains behind the research that is very widely quoted (and misquoted) in the laypress by popular authors such as Malcolm Gladwell’s Outliers. The most important lesson he has for medical educators is that experience alone does not generally result in expertise! Cumulative experience, just by showing up to work (or playing soccer or the violin) does not make one acquire expertise, and is certainly the longest path to achieving gains of any kind...
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