Rapid Cognition
In a flash
Wed/Jul/07 09:05 PM
I have been thinking about Malcolm Gladwell's great book "Blink" (hard on the heels of "Tipping Point"). It is a book of stories and research that highlight the difference between the way in which our conscious mind makes deliberate decisions and the "rapid cognition" of our instinctive/uncounscious mind. In one of this blog's first entries I wrote about how experienced clinicians often correctly make a decision very rapidly based on limited information. These are not guesses, these are ways in which skilled clinicians will trust their instinct in a case.
In the book Gladwell shows how both conscious and the instinctive decisions can be right or prone to be wrong under certain circumstances. Under extreme physical and emotional distress, for instance, we process much less information that helps us read situations and people. We revert to stereotype for information and our processing becomes more like that of the autistic mind....unable to read facial or verbal cues which limits the accuracy of our decisions. At other times thinking through a decision may cause information overload and result in unneeded delay or inaccurate conclusions. In medicine both of these can happen.
When I was teaching actively in the medical school environment, I often told students and residents that if they "just didn't feel right" about a story or a pattern they were seeing they should listen to that feeling. I recall giving a lecture outlining this principle and THAT VERY AFTERNOON a student came to me in clinic with a gut feeling they were missing something. She had been interviewing a woman for about 30 minutes and the complaint was common as was the story but something was not right. I went in the room and introduced myself and recounted a bit of what I had heard from the student. Then I felt strongly compelled to ask the woman "How long has your husband been abusing you?". Never before and never since have I started an interview with that question asked that way. She broke down and related a story of fear and abuse and we started intervention to get her an her family safe. Was I smart? No....I just went with my instinct. But I could not explain why I had done so.
Gladwell's book points out research showing a myriad of facial expressions that may be flashed for a few milliseconds may have been what I "heard" from this patient. In other words it's likely her face flashed me a look of stress/fear that I instinctively recognized without even knowing I had seen it. Very interesting stuff. Often in medicine we order test after test and trust the tests not the patient or the story and then have too much information to sift though. The result is more specialist referrals and more tests NOT necessarily better or more accurate diagnoses.
In the Epilog he makes a case that major decisions (if not make under extreme emotional/physical distress) may be BETTER made by going with a gut feeling and lower level ones may be better with reasoned thought. Many of us know about a job, a decision that we thought through very carefully because it was so important AND WE MESSED IT UP! Similarly we may have made a decision under stress when reading facial or interpersonal cues was key meaning we could not tap into our rapid cognition or our reason....we just chose to stereotype. That decision also was wrong. I have been reflecting on major life choices in the past and facing me now and see how errors were made and wonder if I will do better in the future.
In the book Gladwell shows how both conscious and the instinctive decisions can be right or prone to be wrong under certain circumstances. Under extreme physical and emotional distress, for instance, we process much less information that helps us read situations and people. We revert to stereotype for information and our processing becomes more like that of the autistic mind....unable to read facial or verbal cues which limits the accuracy of our decisions. At other times thinking through a decision may cause information overload and result in unneeded delay or inaccurate conclusions. In medicine both of these can happen.
When I was teaching actively in the medical school environment, I often told students and residents that if they "just didn't feel right" about a story or a pattern they were seeing they should listen to that feeling. I recall giving a lecture outlining this principle and THAT VERY AFTERNOON a student came to me in clinic with a gut feeling they were missing something. She had been interviewing a woman for about 30 minutes and the complaint was common as was the story but something was not right. I went in the room and introduced myself and recounted a bit of what I had heard from the student. Then I felt strongly compelled to ask the woman "How long has your husband been abusing you?". Never before and never since have I started an interview with that question asked that way. She broke down and related a story of fear and abuse and we started intervention to get her an her family safe. Was I smart? No....I just went with my instinct. But I could not explain why I had done so.
Gladwell's book points out research showing a myriad of facial expressions that may be flashed for a few milliseconds may have been what I "heard" from this patient. In other words it's likely her face flashed me a look of stress/fear that I instinctively recognized without even knowing I had seen it. Very interesting stuff. Often in medicine we order test after test and trust the tests not the patient or the story and then have too much information to sift though. The result is more specialist referrals and more tests NOT necessarily better or more accurate diagnoses.
In the Epilog he makes a case that major decisions (if not make under extreme emotional/physical distress) may be BETTER made by going with a gut feeling and lower level ones may be better with reasoned thought. Many of us know about a job, a decision that we thought through very carefully because it was so important AND WE MESSED IT UP! Similarly we may have made a decision under stress when reading facial or interpersonal cues was key meaning we could not tap into our rapid cognition or our reason....we just chose to stereotype. That decision also was wrong. I have been reflecting on major life choices in the past and facing me now and see how errors were made and wonder if I will do better in the future.
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