2020 Hindsight: Obfuscation, Misclassification (I/II), Politicization, Clarification 

Pandemic Primer - 4/4 (promise!)

5-27-21: "...Biden orders intelligence inquiry into origins of the coronavirus..."

                "...who died from COVID? State doesn't really know..."

               "...man exonerated after serving 30 years on new DNA evidence..."

Premature(?) No, not really. Despite the fact that we are not quite done with the pandemic or, more aptly stated, the pandemic is not quite done with us, it is always timely to consider the factors that interfere with good understanding of any condition(s), the cognitive, social, and even 'political' influences that obscure accurate diagnoses, that in turn can lead to over, under treatment, and potentially disastrous  outcomes. Represented as currently this morning, "...Boris Johnson's mishandling of the early part of this pandemic cost thousands of lives..." a quote that could have easily been repeated numerous times with different administration's names substituted. Claims that I indicated would be coming in some of my earlier posts, which was not a bold prediction, given our collective propensity to engage in second guessing, especially after the fact, when we can benefit from...

Hindsight Bias: Also known as "I knew it all along", which has scientifically been shown to be a significant source of an individual's ability to predict outcomes of future events (ranging from writings of historians regarding outcomes of battles or physicians regarding their recall of clinical trials, among a legion of others). Outcomes that highly skilled, intelligent, experienced individuals failed to. Humility once again called for.

Other Usual Suspects, Obfuscators: The lineup of factors that contribute to all of us being prone to making Type I (over-diagnosis, 'false positive') Type II (under-diagnosis, 'false negative') errors in any realm, any discipline -- ranging from medicine, courts of law, classrooms where teachers are making continuous judgments in a target rich environment, or engineers trying to unravel why a vehicle needs to be recalled -- also include those I have brought before you in a prior post but warrant reviewing, as you actively reflect on those most relevant to our/your current, ongoing pandemic circumstances.

Misinterpretation, miscommunication, misunderstanding: Happens daily, everywhere, even when not wearing masks. On the lighter side, it can occur when we get 'auto corrected' on a text and send it out without re-checking, or our thumb hits the 'wrong' emoji...takes on whole different meaning at times. But when this occurs in the OR, for instance, or when a health care worker is trying to understand a patient's request, gestures, or two nations/cultures are in the midst of an important negotiation...

Lack of Awareness: You ask anyone, of any age, of any level of intelligence, WHY they made a certain decision that did not turn out as intended, and you'll frequently get "IDK" as an initial response -- only after many more questions, investigation, reflection do we gain better awareness, clarity. Raising awareness is the first byproduct of an effective therapeutic encounter (often referred to in psychology and law practice as discovery').

Over Confidence: We all 'suffer' from this from time to time, especially as we become more 'expert' in our fields and/or answers appear obvious.

Rush to Judgement: One of the significant sources of stress/trauma for some health care specialists working in the ER's and ICU's lately is not just the increase in numbers of serious cases with which they were confronted (e.g. COVID) but the short amount of time per case resulting from these numbers, having to literally make life and death decisions at a rate not previously experienced, imagined. This also happens when haste is not required, unfortunately. 

Oversimplification: The tendency for all of us to take a complicated set of dynamics and reduce them to only one or a few more manageable equations we can cognitively/emotionally process (use your imagination here).

Overgeneralization: Similar to oversimplification -- the tendency for all of us to make associations based on prior experiences, to minimize having to think beyond the surface...it's related to 'unconscious bias' and stereotypes, which have been shown to be impactful when making certain types of diagnosis at the incorrect times (while once again missing others not so obvious to us).

Over-reliance on Memory: Instead of checking, rechecking,...

Over- or Under- Reliance on Technology, computer algorithms: Can go either way: on the one hand, as a mentor stressed, tests don't ultimately diagnosis (in psychology, for instance), people do ("They're paying us for our thinking!", he used to emphasize). On the other, if we think we can outthink algorithms that have been derived by highly sophisticated and experienced math and computer science majors, in combination/consultation with others specializing with the particular matter at hand....like when the best Jeopardy champs tried to outwit the AI dude, "Watson". It's best when we have intelligent people utilizing intelligence in the most intelligent and informed manner...you see where I'm going with this, right?

Accumulation, Combination: The foregoing categories do not, of course, occur in isolation of one another, often occurring either in tandem or rapid succession in an increasingly perilous manner. All of these, even without considering the undue influence of politics, whether internal to an organization/institution, or responding to external pressures. 

       

       Not too glamorous or entertaining, any or all of this, I admit. But very, very critical to be first aware of our own culpability, vulnerability to these sources of errors. Presenting all the strategies and tools (cognitive, interactive, clinical) to prevent, mitigate, and/or offset the potential impact of these sources is beyond the 'text' of this post, space, but perhaps for another day, well after you have had the chance to recover from processing all this. In the meantime...

 A headline I would alter, to enhance diagnosis (one word pivot makes all the difference): "Biden orders an intelligent look into..." (wouldn't that be  more effective, enhance outcome?😀)