September 8, 2009
from In Search of Tools to Aid Logical Thinking and Communicating about Medical Decision Making, by M. G. MYRIAM HUNINK, MD, PhD Med Decis Making 2001;21:267–27
In Search of Tools to Aid Logical Thinking and
Communicating about Medical Decision Making
M. G. MYRIAM HUNINK, MD, PhD
“The discussions always seem to go along the same lines: Dr. Smith says that he feels that treatment X is the right thing to do because he recently read a paper that mentioned that X was beneficial; Dr. Johnson counters that X has a substantial risk associated with it, as was shown in the paper published last year in the world’s highest ranking journal in the field, and should therefore not be considered; and Dr. Gray says that given the current limited budget in the department, maybe we should consider a less expensive alternative or no treatment at all. After talking around in circles for about 10 to 15 minutes, with each doctor reiterating his or her opinion and new facts popping up from time to time, the professor of vascular surgery finally stops the discussion, realizing that his fellows are getting irritated because they have work to do. Practical chores are waiting. And so the professor concludes, “Okay. So it seems we should be doing treatment X.” About 40% of those involved in the decision-making process nod their heads in agreement, another 40% start bringing up objections (which get stifled quickly by the fellows who really don’t want an encore), and the remaining 20% of those involved are either too tired or too flabbergasted to respond or are optimizing another goal in life, namely, job security. Does this sound familiar?”
Illustrates how medical experts have the same problems with deliberative decision as everyone else.
May 25, 2009
“On balance, one must weigh up the pros and cons, look at the data, and then use intuition where there is missing data. It is difficult to move very far in leadership without having intuition, without being able to go by gut feeling. At some point the data is not there; that is when you will need to make a decision that is difficult.”
Terry Corby, Senior Executive, Accenture
February 24, 2009
Foster’s cans 330ml stubbies
Brewing giant Foster’s is sheepishly reversing a marketing brain snap in Australia that tried charging the same price for less beer in a smaller “European-style” stubbie.
February 4, 2008
“In any moment of decision, the best thing
you can do is the right thing; the next best thing is the wrong thing;
and the worst thing you can do is nothing.”
— Theodore Roosevelt 26th President of the U.S.
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September 10, 2007
Study finds left-wing brain, right-wing brain
“Exploring the neurobiology of politics, scientists have found that
liberals tolerate ambiguity and conflict better than conservatives
because of how their brains work.”
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August 6, 2007
Getting Iraq Wrong by Michael Ignatieff in the NY Times
“Michael Ignatieff, a former professor at Harvard and contributing writer for the magazine, is a member of Canada’s Parliament and deputy leader of the Liberal Party.”
- “The unfolding catastrophe in Iraq
… has condemned the judgment of many others, myself included, who as
commentators supported the invasion…I keep revisiting the Iraq debacle, trying to understand exactly how
the judgments I now have to make in the political arena need to improve
on the ones I used to offer from the sidelines.”
- “The attribute that underpins good judgment in politicians is a sense of
cannot afford to cocoon themselves in the inner world of their own
imaginings. They must not confuse the world as it is with the world as
they wish it to be.”
- “The only way any of us can improve our grasp of reality is to confront
the world every day and learn, mostly from our mistakes, what works and
what doesn’t. Yet even lengthy experience can fail us in life and in
politics. Experience can imprison decision-makers in worn-out solutions
while blinding them to the untried remedy that does the trick.”
- “In practical politics, there is no science of decision-making. “
- “A sense of reality is not just a sense of the world as it is, but as it
might be. Like great artists, great politicians see possibilities
others cannot and then seek to turn them into realities. To bring the
new into being, a politician needs a sense of timing, of when to leap
and when to remain still. Bismarck famously remarked that political
judgment was the ability to hear, before anyone else, the distant
hoofbeats of the horse of history.”
- “Fixed principle matters. There are some goods that cannot be traded,
some lines that cannot be crossed, some people who must never be
betrayed. But fixed ideas of a dogmatic kind are usually the enemy of
good judgment. It is an obstacle to clear thinking to believe that
America’s foreign policy serves God’s plan to expand human freedom.
Ideological thinking of this sort bends what Kant called “the crooked
timber of humanity” to fit an abstract illusion.”
- “The people who truly showed good judgment on Iraq predicted the
consequences that actually ensued but also rightly evaluated the
motives that led to the action. They did not necessarily possess more
knowledge than the rest of us. They labored, as everyone did, with the
same faulty intelligence and lack of knowledge of Iraq’s fissured
sectarian history. What they didn’t do was take wishes for reality.”
- “emotions in politics, as in life, tend to be self-justifying and in
matters of ultimate political judgment, nothing, not even your own
feelings, should be held immune from the burden of justification
through cross-examination and argument.”
These observations seem to be just as true as business as they are of politics.
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August 2, 2007
The Cult of Committee by Barbara Kiviat in Time Magazine.
Interesting piece on group decision making in an investment firm.
- “There are a zillion independent variables, and it’s very hard for one person to think about them all.”
- “When an analyst thinks a company is something Dodge & Cox would be
well advised to hold for five years, the analyst makes the case to an
- “It’s not a strict vote…The process…is like
taking the temperature of the room.”
- “That ability to make complex strategic decisions collectively requires
an almost Benedictine devotion to corporate togetherness, starting with
- “Dodge & Cox has also found there to be an important structural
element to team decision making. “Committees react best to a specific
proposition,” says Bryan Cameron, director of research and a member of
the committees that pick domestic and foreign stocks. So when analysts
make a presentation, they propose a particular course of
action–increasing the percentage of Wal-Mart from 2% of the portfolio
to 2.2%, say. The analyst advocates, and the committee
meditates–somewhat like a jury.”
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