Posted on in General

In high velocity environments, like healthcare, speed of decision making is important. The emergency room doctor has to have an immediate response to the motor vehicle accident victim on the gurney in the trauma room.

Complex patients with one or many diseases are different. They require doctors to take the time to engage and think more deeply about the case.

Speedy decision makers don’t take the time to generate alternatives and then assess the pros and cons of each of these alternatives.  They engage in fast pattern matching. They interpret the external cues and conditions and create a pattern. They match that pattern with the patterns from their prior experiences. The fast decision makers sense, interpret, create the pattern and then match patterns. This process is automatic or pre-conscious. The matching usually results in one answer. If the decision maker has a richer set of prior experiences, then there will be more patterns on file and more nuance in his/her decision making.

Doctors work in high velocity environments. They are, on balance, intelligent. They are fast thinkers. Their colleagues expect them to find the answer quickly.  Patients expect the doctor to arrive at the answer quickly and decisively. There is no time to “noodle” the case.

Unfortunately, the process of speedy decision making can lead to medical mistakes. The richness in the diagnostic process is created by evaluating alternatives.  If only one answer is derived quickly, then a number of possibilities are not considered.

So, how can the patient change this uber fast thinking in order to avoid possible mistakes and enrich the decision making process?

At either the first or possibly second meeting with the doctor, the patient could ask some questions in order to create doubt about the speedy decision.  This is not to devalue the doctors advice but to force the thinking to go deeper.

The patient might confer with a friend who is a doctor or with the family doctor to draft the questions.

At the meeting with the doctor, the patient might ask the questions and possibly describe some alternatives with possible supporting evidence. Even if the alternatives are dismissed, this exercise will encourage the doctor to think more deeply about the patient’s scenario and hopefully avoid a medical mistake.

To learn more about this refer to Daniel Kahneman’s work on heuristics and cognitive bias.