Finished on 17/2/18 in Brisbane, Australia.
"To be a good diagnostician, a physician needs to acquire a large set of labels for diseases, each of which binds an idea of the illness and its symptoms, possible antecedents and causes, possible developments and consequences, and possible interventions to cure or mitigate the illness. Learning medicine consists in part of learning the language of medicine. A deeper understanding of judgements and choices also requires a richer vocabulary than is available in everyday language. the hope for informed gossip is that there are distinctive patterns in the errors people make. Systematic errors are known as biases, and they recur predictably in particular circumstances. When the handsome and confident speaker bounds onto the stage, for example, you can anticipate that the audience will judge his comments more favourably than he deserves. The availability of a diagnostic label for this bias - the halo effect - makes it easier to anticipate, recognise and understand."
"Jumping to conclusions is efficient if the conclusions are likely to be correct and the costs of an occasional mistake are acceptable, and if the jump saves much time and effort. Jumping to conclusions is risky when the situation is unfamiliar, the stakes are high, and there is no time to collect more information. These are the circumstances in which intuitive errors are probable, which may be prevented by a deliberate intervention of System 2."
"If we think a baseball pitcher is handsome and athletic, for example, we are likely to rate him better at throwing the ball, too. Halos can be negative if we think a player is ugly, we will probably underrate his athletic ability. The halo effect helps keep explanatory narratives simple and coherent by exaggerating the consistency of evaluations: good people do only good things and bad people are all bad. The statement “Hitler loved dogs and little children” is shocking no matter how many times you hear it, because any trace of kindness in someone so evil violates the expectations set up by the halo effect. Inconsistencies reduce the ease of our thoughts and the clarity of our feelings."
"Hindsight bias has pernicious effects on the evaluation of decision makers. It leads observers to assess the quality of a decision not by whether the process was sound but by whether its outcome was good or bad. Consider a low-risk surgical intervention in which an unpredictable accident occurred that caused the patient’s death. The jury will be prone to believe. after the fact, that the operation was actually risky and that the doctor who ordered it should have known better. This outcome bias makes it almost impossible to evaluate a decision properly - in terms of the beliefs that were reasonable when the decision was made."
"Although hindsight bias and the outcome bias generally foster risk aversion, the also bring undeserved rewards to irresponsible risk seekers, such as a general or an entrepreneur who took a crazy gamble and won. Leaders who have been lucky are never punished for having taken too much risk. Instead, they are believed to have had the flair and foresight to anticipate success, and the sensible people who doubted them are seen in hindsight as mediocre, timid and weak. A few lucky gambles can crown a reckless leader with a halo of prescience and boldness."
"Among medical specialties, anaesthesiologists benefit from good feedback, because the effects of their actions are likely to be quickly evident. In contrast, radiologists obtain little information about the accuracy of the diagnoses they make and about the pathologies they fail to detect. Anesthesiologists are therefore in a better position to develop useful intuitive skills. If an anaesthesiologist says, “I have a feeling something is wrong,” everyone in the operating room should be prepared for an emergency."
"A study of patients who died in the ICU compared autopsy results with the diagnosis that physicians had provided while the patients were still alive. Physicians also reported their confidence. The result: “clinicians who were ‘completely certain’ of the diagnosis antemortem were wrong 40% of the time.” Here again, expert overconfidence is encouraged by their clients: “Generally, it is considered a weakness and a sign of vulnerability for clinicians to appear unsure. Confidence is valued over uncertainty and there is a prevailing censure against disclosing uncertainty to patients.”
Eta S. Berner and Mark L. Graber, “Overconfidence as a Cause of Diagnostic Error in Medicine,” American Journal of Medicine 121 (2008): S24-S29."
"In intuitive evaluations of entire lives as well as brief episodes, peaks and ends matter but duration does not."
"For another thought experiment, imagine you face a painful operation during which you will remain conscious. You are told you will scream in pain and beg the surgeon to stop. However you are promised an amnesia-inducing drug that will completely wipe out any memory of the episode. How do you feel about such a prospect? Here again, my informal observation is that most people are remarkably indifferent to the pains of their experiencing self. Some say they don’t care at all. Others share my feeling, which is that I feel pity for my suffering self but not more than I would feel for a stranger in pain. Odd as it may seem, I am my remembering self, and the experiencing self, who does my living, is like a stranger to me."
"The rules that govern the evaluation of the past are poor guides for decision making. Because time does matter. The central fact of our existence is that time is the ultimate finite resource, but the remembering self ignores that reality. The neglect of duration combined with the peak-end rule causes a bias that favours a short period of intense joy over a long period of moderate happiness. The mirror image of the same bias makes us fear a short period of intense but tolerable suffering more than we fear a much longer period of moderate pain. Duration neglect also makes us prone to accept a long period of mild unpleasantness because the end will be better, and it favours giving up an opportunity for a long happy period if it is likely to have a poor ending."