Jim,
This seems to me to make a greater point for exploring the multiple, interacting, parallel connections for their roles in human decision making...it seems we could do more with what we have if we identified even one barriers and identified a work around/solution or even that it was not possible and why. If we simply identified this in one sector empirical evidence could emerge and theory would be testable.
Amy
-----Original Message-----
From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Jim Walker
Sent: 25 March 2011 10:25 AM
To: [log in to unmask]
Subject: Re: Clinical Decision Making and Diagnostic Error
Two flies in the ointment:
The first is that the neocortex is far more efficient than any computer
designed yet, as many as 4-6 orders of magnitude.
The second fly is information input: many of our sensors' receptive
capabilities--and especially their multiple, interacting, parallel
connections to various regions in the neocortex and other brain
regions--dwarf those of the sensors available for computers.
Jim
James M. Walker, MD, FACP
Chief Health Information Officer
Geisinger Health System
>>> "Dr. Carlos Cuello" <[log in to unmask]> 3/25/2011 9:30 AM >>>
I would bet that in a decade or two, Watson will be our SYSTEM in the
6s
pyramid of Haynes (I wrote an entry in my blog about this =)
http://www.sinestetoscopio.com/?p=1417
check the videos below the entry
Cheers
On Fri, Mar 25, 2011 at 06:13, Djulbegovic, Benjamin <
[log in to unmask]> wrote:
> Wow- will IBM bet on Watson (a computer, which appears to emulate
human
> intelligence better than any other AI system before) is going to be
a (the
> ultimate?) solution of complexity in medical decision-making?
> ben
>
> -----Original Message-----
> From: Dr. Amy Price [mailto:[log in to unmask]]
> Sent: Thursday, March 24, 2011 11:25 PM
> To: Djulbegovic, Benjamin; [log in to unmask]
> Subject: RE: Clinical Decision Making and Diagnostic Error
>
> Fastest processor as of 2010?
>
> I think it may be this one
> The IBM z196 processor can execute 50 billion instructions per
second,
> which makes the current generation of desktop processors look like a
pauper.
> The CPU also has 1.4 billion transistors. The CPU also has a 64KB L1
> instruction cache, 128KB L1 data cache and a 1.5 L2 cache (Tom's
Hardware)
>
> Amy
>
> -----Original Message-----
> From: Evidence based health (EBH)
> [mailto:[log in to unmask]] On Behalf Of
Djulbegovic,
> Benjamin
> Sent: 24 March 2011 07:50 PM
> To: [log in to unmask]
> Subject: Re: Clinical Decision Making and Diagnostic Error
>
> perhaps we identify with the conscious but not with the
non-conscious
> because we consider technological and other advances as an integral
part of
> our logical, conscious system...but I don't believe that with all
inventions
> at our disposal we are close to processing 10,000,000 bits of
information
> per second (and without overheating!) BTW, what is the fastest
modern
> computer in terms of processing power?
> ben
>
> ________________________________________
> From: Jim Walker [[log in to unmask]]
> Sent: Thursday, March 24, 2011 4:13 PM
> To: Djulbegovic, Benjamin; [log in to unmask]
> Subject: Re: Clinical Decision Making and Diagnostic Error
>
> The non-conscious system is massively parallel and processes
something on
> the order of 10,000,000 bits of information per second, the
conscious
> between 16 and 32 bits.
> So the conscious is something like the tip of a fully integrated
iceberg,
> dependent on the pre-processing of disparate inputs by the
non-conscious
> system for the highly (and necessarily) filtered information which
it
> manipulates.
> So while the conscious can direct the attention of some aspects of
the
> non-conscious system to some extent, there is no theoretical or
empiric
> reason to think that the conscious system can "train" the
non-conscious--or
> that we would benefit if it could. (Interesting how we identify with
the
> conscious but not with the non-conscious.)
>
> Jim
>
> James M. Walker, MD, FACP
> Chief Health Information Officer
> Geisinger Health System
>
>
> >>> "Djulbegovic, Benjamin" <[log in to unmask]> 3/24/2011 3:31
PM
> >>> >>>
>
> Hi Amy,
> I am at the moment reading some papers by Read Montague (from
Baylor)...
> He has written some interesting stuff...
> Best
> ben
>
> From: Dr. Amy Price [mailto:[log in to unmask]]
> Sent: Thursday, March 24, 2011 3:13 PM
> To: Djulbegovic, Benjamin; [log in to unmask]
> Subject: RE: Clinical Decision Making and Diagnostic Error
>
> Dear Ben ,Neal and all,
>
> I am interested in the fMRI data identifying discrete brain areas
for
> systems 1 and 2. I am particularly intrigued by how/when they link
and if
> the unconscious bias might be trained . Do you have authors names,
links or
> papers you could share. I am looking at this area in regards to
addiction
> and collaborating with others who are identifying genomics.
Presently
> exploring QEEG to see if this uncovers anything of interest...
>
> Best regards,
> Amy
>
> From: Evidence based health (EBH)
> [mailto:[log in to unmask]] On Behalf Of
Djulbegovic,
> Benjamin
> Sent: 24 March 2011 02:55 PM
> To: [log in to unmask]
> Subject: Re: Clinical Decision Making and Diagnostic Error
>
>
> Neal,
> Thanks for these insights - it is a really interesting thought about
the
> fMRI data identifying discrete brain areas as location of system 1
and
> system 2 (at the moment, I am too reading on this fascinating stuff,
and
> after you pointed this out, I wonder what would Hammond say about
the
> empirical data that seems to be falsyfying his thesis?) Regarding
which
> reasoning system gets its more right than wrong, I think we are
saying the
> same thing, except (that in my reading of Hammond he seems to be
saying)
> that when we get it wrong, the consequences of relying on intuition
vs.
> logic are of the magnitude order less significant? (We are, of
course,
> talking about decisions related to human affairs and social policies,
not to
> the stuff in the realm of the quantum physics!) Best ben
>
> From: Evidence based health (EBH)
> [mailto:[log in to unmask]] On Behalf Of Maskrey
Neal
> Sent: Thursday, March 24, 2011 2:04 PM
> To: [log in to unmask]
> Subject: Re: Clinical Decision Making and Diagnostic Error
>
> Ben
>
> Good to hear from you. Spring's arrived in England and it's lovely,
but it
> sure ain't Florida!
>
> My reading is slightly different. From that, neither system 1 nor
system 2
> are superior, but system 1 is our "default". If we are talking about
errors
> of commission, then then Pat Coskerry shows these occur predominately
in
> system 1 due to the common cognitive and affective biases. My own
personal
> dramatic memories are fortunately few in number, but when I got it
wrong the
> usual contributing factors were availability bias and affective -
notably
> work overload and sleep deprivation. And I'm sure Hammond isn't right
about
> us never being spectacularly wrong in system 1. In system 2 the
common
> problem is omission - if a common medical emergency presents it
isn't
> optimal to have to spend lots of time working out the diagnosis and
> treatment plan. Broadly speaking, as Pat Croskerry says, we're safer
in
> system 2 - but we're a lot slower.
>
> The MRI emission data identifies particular and quite different areas
of
> the brain being used live with system 1 and system 2 decision making
and
> that's harder to explain as a continuum - happy to debate. We've
obviously
> "cartooned" some of this necessarily in these brief,
awareness-raising group
> discussions and one of the facets we've not mentioned is the frequent
live
> toggling in decision making between system 1 and system 2.
>
> The key trick is to train people to step back and re-examine the
> issue...both from logical (system 2) and affective side (system
1)...a tough
> to do when decisions have to be made in a short time-frame...
>
> Absolutely. The next step is to prove teaching these approaches
changes
> behaviour, and then that change in behaviour improves the processes
used in
> decision making if that's possible. Showing improved outcomes or less
errors
> or both would be ideal, but if we're honest the definitive
literature
> showing "teaching EBM" or for that matter teaching anatomy or
teaching
> genetics improves outcomes isn't massive either. The quick "could
this be
> anything else" or "are there any other / better treatment options" or
"did I
> check for contraindications / interactions" calibration at the end of
the
> consultation is simply plain old fashioned good medical practice, so
if this
> is well presented its (a) an interesting subject to teach and learn,
and (b)
> some of the content has excellent face validity for students.
Likewise the
> more leisurely reflection - but then maybe the St Pete police would
want
> drivers to be concentrating on the road!
>
> I keep hearing about on going research which might move all of this
> forward, and there's certainly lots of interest. Fabulous.
>
> Best
>
> Neal
>
> Neal Maskrey
> National Prescribing Centre
> Liverpool UK
>
> ________________________________
> From: Evidence based health (EBH)
> [mailto:[log in to unmask]] On Behalf Of
Djulbegovic,
> Benjamin
> Sent: 24 March 2011 11:02
> To: [log in to unmask]
> Subject: Re: Clinical Decision Making and Diagnostic Error
>
>
> Neal, a challenge is, of course, to know when to use our intuitive
(system
> 1) vs. logical (system 2) inferential process...Kenneth Hammond, who
has
> promoted idea of a continuum between system 1 and system 2 (instead
two
> sharply demarcated systems), has made a point that if we rely on the
system
> 1, we will often be more wrong than right, but never spectacularly
wrong. On
> other hand, reasoning based on system 2 (this would include EBM)
would be
> more often right, but when it is wrong it can be phenomenally wrong
(as our
> models of the world can be hugely mistaken)... A
practical/educational
> corrolary from this is "rely on EBM, but if it does not agree with
your
> intuition, don't go there go/re-examine your decision..." The key
trick is
> to train people to step back and re-examine the issue...both from
logical
> (system 2) and affective side (system 1)...a tough to do when
decisions have
> to be made in a short time-frame...My own approach has been to ask
> students/residents/fellows is a) to review mentally all
patient'stories
> ("cases") at the end of the day and focus on any possible
oversights/errors
> that may occurred that day (e.g. while driving back home), b) ask
yourself "
> if I were the patient, would I like to be taken care by thy guy/girl
like
> me?"
>
> I have been doing this for years- wish I can report that I found the
> "solution"...unfortunately, I still find myself much deficient as I
try to
> answer these questions...but resoluted to do better next day...
>
> ben djulbegovic
>
>
>
>
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--
Carlos A. Cuello-García, MD
Director, Centre for Evidence-Based Medicine
Tecnologico de Monterrey School of Medicine
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