Biases and Debiasing - Society to Improve Diagnosis in Medicine消除社会偏见和提高医学诊断.pptVIP

Biases and debiasingPat Croskerry MD, PhD  The Biases Affective Cognitive Social/Cultural Affective Bias When the affective state of the decision maker adversely affects decision making Due to a failure in rational/logical decision making Usually due to ‘hot emotion’ (vivid-tepid continuum) There are about 20 known affective biases Universal Predictable Correctable (affective de-biasing) HOT COOL The Emotional Spectrum Cognitive and affective debiasing Four major issues Getting people to recognize there is a problem Accepting that change must occur Choosing an appropriate debiasing strategy Teaching and sustaining debiasing strategies Many clinicians are unaware of the problem… And some people will never change… So how do we become better decision makers? REMEMBER Most of our biases live in the intuitive mode (System 1) The most important step is de-coupling from System 1 Pattern Recognition Repetition Executive override Dysrationalia override Calibration Diagnosis Patient Presentation Pattern Processor RECOGNIZED NOT RECOGNIZED Type 1 Processes Type 2 Processes T Executive override Thinking about how we think Reflection Mindfulness Metacognition System 2 monitoring of System 1 System 2 modulation of System 1 Cognitive decoupling from System 1 Cognitive debiasing We need to maintain a feral vigilance to detect biases It ain’t easy Even though bias detected Very unlikely one strategy works for all Need for multiple approaches Very unlikely one shot will work Need for multiple innoculations Need for extra vigilance in critical conditions Need for lifelong maintenance Issues that impede cognitive and affective de-biasing Variable Descriptor Clinical relevance Cognition has not been seen as the business of medicine. Cognitive processes are not usually studied by clinicians except in disease states such as brain injury, dementia, autism and others. Lack of awareness Many clinicians are na?ve about cognitive processes