It could be the rancor of over-exposed political debates but have you noticed how the facts often don't align with media soundbites. To take it a step further--when you hear opinions from the populace at large they often support their convictions with quotes extracted from the very same misrepresented catchy headline. I think we can guess they are not picking up their heavy rocks.
Biases, heuristics, and subjective considerations are certainly not all wrong or bad. The trick is knowing when you may be unintentionally filtering out entire perspectives or opposing views. Don't click if a few naughty words make you come unglued but one of my favorite songs by Gorillaz--Clint Eastwood-- has this lyric, "Y'all can see me now 'cause you don't see with your eye You perceive with your mind". This reminds me of the importance of using all of your senses when making important determinations. Sebastian Seung is mapping a massively ambitious new model of the brain that focuses on the connections between each neuron. He calls it our "connectome," and it's as individual as our genome — and understanding it could open a new way to understand our brains and our minds.--The Connectome Synapses can be created, and they can be eliminated.And synapses can grow larger, and they can grow smaller. Second question: what causes these changes? Well, it's true. To some extent, they are programmed by your genes. But that's not the whole story, because there are signals, electrical signals, that travel along the branches of neurons and chemical signals that jump across from branch to branch. These signals are called neural activity. The connectome of C. elegans...
I began my morning with strong coffee and a read of the latest articles about medical errors. The BMJ reported the study, Medical error-the third leading cause of death in the US.
Based on an analysis of prior research, the Johns Hopkins study estimates that more than 250,000 Americans die each year from medical errors. On the CDC's official list, that would rank just behind heart disease and cancer, which each took about 600,000 lives in 2014, and in front of respiratory disease, which caused about 150,000 deaths.--NPR, Medical Errors Are No. 3 Cause Of U.S Deaths, Researchers Say
"It boils down to people dying from the care that they receive rather than the disease for which they are seeking care,"-- Martin Makary, a professor of surgery at the Johns Hopkins University School of Medicine
"There has just been a higher degree of tolerance for variability in practice than you would see in other industries"--Researchers: Medical errors now third leading cause of death in United States
There are plenty of pundits with differing opinions of the cause of the high rate of errors with many stating that the harm may be understated. I would bet on the deluge of clinical reports, guidelines, and ever evolving algorithms as contributors to the dilemma. Let's face it--physicians don't join the profession to do harm. So what gives?
Sharpen your perception, change your life (and opinions)
Full disclosure. I love art. I confess to belonging to museums in states where I don't live. This particular application of art to perception and visual intelligence checked a lot of boxes useful for the debate on "value" in medicine and yes, medical errors (if described as a disease) being the 3rd leading casue of death. Amy Herman is a lawyer and art historian--and lived in my neighborhood growing up. She describes a program--Yale medical students were brought to an art museum and in the absence of contextual knowledge were challenged to describe paintings or other pieces of art.
No surprise, diagnostic skills improved. Her book, Visual Intelligence, describes programs in medicine, law enforcement, and even the military. The title of this post originated from an alternative title for the book. If you are a stakeholder in the healthcare industry you have been bombarded about advances in healthcare technology. Therein may be the problem. Doctors are increasingly reliant on technology. Once laboratory values, imaging results, or data has been reviewed, the patient is often afforded only a quick confirmatory glance. In clinical education we were always taught "when you hear hoofbeats--think horses not zebras". A useful heuristic but the confirmatory biases can stack up at an alarming rate. The truth of the matter? By the time our eyes perceive, our brains are already processing the information. Amy suggests, that a lack of visual intelligence is the biggest chasm between what we see and how we communicate what we see. It is possible to learn to frame questions to illicit the information that we need--be as specfic as possible and frame questions with objectivity and clarity. Because the brain is unable to handle the amount of information we encounter on a daily basis--we tend to filter out what we feel we don't need. The damage occurs when we are inert to conflicting information, details, or nuances. Listen to the interview with Amy on The Leonard Lopate Show. She describes the William Eggleston photograph of a freezer as a compelling example of perception and inference. We have observations from all of our senses to inform our perceptions. It is those perceptions that inform inferences. Amy provides the line between our perception that the freezer has been neglected but cautions against the assumption--the owner is a slob. Does the information we are provided visually support the inference? Or are we bringing our own heuristics to the inference. We need more information. 
Perhaps it was the caffeine but I see parallels with a recent article, in NEJM, __What Do I Need to Learn Today? — The Evolution of CME by Graham T. McMahon, M.D.
"I envision a future in which educational expectations and professional competency obligations are aligned and integrated and in which all physicians have an educational “home” that helps them navigate their continuing growth — so that education is intertwined with practice throughout their careers." "...we find only the world we look for" Henry David Thoreau
Thoughtful discussions about content development and outcomes analytics that apply the principles and frameworks of health policy and economics to persistent and perplexing health and health care problems...
Would you like to connect? I will be attending, Weighty Matters: Advances in Diabetes, Obesity and Metabolism Research at the National Press Club in DC, International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 21st International Meeting, and The American Diabetes Association 76th Scientific Sessions--more dates to come.
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