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A Piece of My Mind
September 13, 2016

Snakes on a Dock

Author Affiliations
  • 1Institute of Health Policy, Management and Evaluation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  • 2Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
JAMA. 2016;316(10):1043-1044. doi:10.1001/jama.2016.5179

For the past decade, I have been thinking about the way our minds make judgments. It started with research on how financial and other conflicts of interest affect published conclusions1 and recommendations. My focus then moved onto diagnostic reasoning and metacognition (thinking about thinking). In the last 2 years, I have begun to think about how to teach cognitive processes to medical students, residents, and practicing physicians.2 These efforts involve explaining theoretical constructs like prospect theory3 and common biases that introduce error (anchoring, early closure, availability, ego, etc4). But frankly, when I discuss these topics with trainees, I can see their eyes glaze over and their attention wander back to the pressing patient care issues of the day. These concepts are simply too abstract to resonate with most physicians.

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