Thinking systems

• System 1 thinking: automatic, unconscious (fast) thinking that uses heuristics
• System 2 thinking: effortful, conscious (slow) thinking that uses computation

Cognitive dispositions to respond (CDRs)

• Heuristics are mental shortcuts that allow people to solve problems and make judgements quickly and efficiently, based on past experiences
• While heuristics are helpful in many situations, they can also lead to biases
• CDRs are failed heuristics

Debiasing CDRs in a clinical context

• Always ask 'what else could this be?'
• Avoid early judgements and preconceptions, always consider comorbidity
• Try to disconfirm initial hypothesis/routinely question the basis of clinical decisions
• Judge cases on their own merits rather than recent experiences
• Routinely consider, and argue the case for and against, several diagnoses or treatments
• Think the opposite
• Slow down
• TWED checklist
  • Life or limb Threat - what are the life/limb threatening conditions in this patient
  • Wrong - what if I am wrong? What else could it be?
  • Evidence - do I have sufficient evidence for/against this diagnosis
  • Dispositional factors - what are the environmental and emotional dispositions influencing my decision

CDRs as hindrance to learning

• Fundamental attribution error: the tendency to be judgmental and blame people rather than examine the circumstances that might have been responsible
• Hindsight bias: knowing the outcome may profoundly influence the perception of past events and prevent a realistic appraisal of what actually occurred, compromising learning either through an underestimation or overestimation of the decision maker's abilities