Adonis Diaries

Posts Tagged ‘Analytic reasoning

Is it the less information the better in critical split-second decision cases?

ER of Cook County Hospital (Chicago)

ER of Cook County Hospital (Chicago) on West Harriston Street, close to downtown, was built at the turn of last century. I was home of the world’s first blood bank, cobalt-beam therapy, surgeons attaching severed fingers, famous trauma center for gangs’ gunshot wounds and injuries…and most famous for the TV series ER, and George Cluny

In the mid 90’s. the ER welcomed 250,000 patients a year, mostly homeless and health non-insured patients… Smart patients would come the first thing in the morning to the ER and pack a lunch and a dinner.  Long lines crowded the walls of the cavernous corridors…

There were no air-conditioners: During the summer heat waves, the heat index inside the hospital reached 120 degrees. An administrator didn’t last 8 seconds in the middle of one of the wards.

There were no private rooms and patients were separated by plywood dividers.

There were no cafeteria or private phones: The single public phone was at the end of the hall.

One bathroom served all that crowd of patients.

There was a single light switch: You wanted to light a room and the entire hospital had to light up…

The big air fans, the radios and TV that patients brought with them (to keep company), the nurses’ bell buzzing non-stop and no free nurses around… rendered the ER a crazy place to treat emergency cases

Asthma cases were numerous: Chicago was the world worst in patients suffering from asthma…

Protocols had to be created to efficiently treat asthma cases, chest pain cases, homeless patients…

About 30 patients a day converged to the ER complaining of chest pains (potential heart attack worries) and there were only 20 beds in two wards for these cases.

It cost $2,000 a night per bed for serious intensive care, and about $1,000 for the lesser care (nurses instead of cardiologists tending to the chest pain patient…)

A third ward was created as observation unit for half a day patients.  Was there any rational protocol to decide in which ward the chest-pain patient should be allocated to? It was the attending physician call, and most of the decisions were wrong, except for the most obvious heart attack cases…

In the 70’s, cardiologist Lee Goldman borrowed the statistical rules of a group of mathematicians for telling apart subatomic particles. Goldman fed a computer data of hundreds of files of heart attack cases and crunched the numbers into a “predictive equation” or model.

Four key risk factors emerged as the most critical telltale of a real heart attack case:

1. ECG (the ancient electrocardiogram graph) showing acute ischemia

2. unstable angina pain

3, fluid in the lungs

4. systolic blood pressure under 100…

A decision tree was fine-tuned to decide on serious cases. For example:

1. ECG is normal but at least two key risk factors are positive

2. ECG is abnormal with at leat one risk factor positive…These kinds of decision trees…

The trouble was that physicians insisted on letting discriminating factors muddle their decisions. For example, statistics had shown that “normally” females do not suffer heart attack until old age, and thus a young female might be sent home (and die the same night) more often than middle-aged black or older white males patients…

Brendan Reilly, chairman of the hospital department of Medicine, decided to try Goldman decision tree.  Physicians were to try the tree and their own instincts for a period.  The results were overwhelmingly in favor of the Goldman algorithm…

It turned out that, if the physician was not bombarded with dozens of pieces of intelligence and just followed the decision tree, he was better off in the allocation to ward process…

For example, a nurse should record all the necessary information of the patients (smoker, age, gender, overweight, job stress, physical activities, high blood pressure, blood sugar content, family history for heart attacks, sweating tendencies, prior heart surgeries,…), but the attending physician must receive quickly the results of the 4 key risk factors to decide on…

Basically, the physician could allocate the patient to the proper ward without even seeing the individual and be influenced by extraneous pieces of intelligence that are not serious today, but could be potential hazards later on or even tomorrow…

Mind you that in order to save on medical malpractice suits, physicians and nurses treating a patient must Not send the patient any signals that can be captured as “contempt”, feeling invisible and insignificant

Many factors are potential predictors for heart attack cases, but they are minor today, for quick decisions…

No need to overwhelm with irrelevant information at critical time.  Analytic reasoning and snap judgment are neither good or bad: Either method is bad at the inappropriate circumstances.

In the “battle field” the less the information coming in, the less the communication streams and the better the rapid cognition decisions of field commanders…

All you need to know is the “forecast” and not the numbers of temperature, wind speed, barometric pressure…

Note: post inspired from a chapter in “Blink” by Malcolm Gladwell

Choice decision strategy: Analytic reasoning or split-second instinct decision?

For simple short-term and non-life threatening decision choices, thinking hard on the few variables affecting the decision does generate the best satisfactory choice.

For the longer-term and very important decisions, such as profession to pursue, mate,…anything that would affect you for most of your life…thinking hard on the interactions of the complex varieties of factors is necessary as a first stage, but you need to take a long break before any decision, and let your unconscious mind select for you.  

You have got to trust your unconscious mind to decide for you since the Big Brain knows your real nature, your deeper inner need, and is better than sophisticated analytic methods for important matters that affect you

Ap Dijksterhuis, a psychologist at the Univ. of Amsterdam, conducted controlled experiments and field experiments on choice decisions methods.  For example, shoppers for simple kitchen utensils and appliances, those who considered the choices from different angles and thought hard on all the pros and cons, were very satisfied with their choices weeks later. Those who relied on instinct ended up very dissatisfied.

Shoppers for furniture and remodeling their homes, a complex problem, were most satisfied when they allowed their “instinct” to prevail at the end of the day.

This decision-making system is valid in politics, managerial jobs…It can be generalized to many facet of life decisions.

Another example. Physicians in emergency rooms rely on their “tested” initial instinct for diagnosing patients with chest pains. Statistics have shown that physician instincts were more often than not faulty and not that good after all. What could be the alternative?

How to re-educate the instinct of physicians?

Analyzing reams of data, Lee Goldman used complex computer models to identify a few key factors and symptoms that seemed to be the most significant in the diagnostic  of chest pain.  Once the physicians were re-educated and aware of the new story the data were telling them, the initial instinct decision of physicians were vastly improved.

That is what artificial intelligence programs are meant to provide: Re-educating how we make “split-second decision”, after we understand thoroughly the problem.

Suppose you are a teacher, how would you weight the results of standardized tests and how much do you weight your judgment about the student’s motivation, attitude, and prospects?

Suppose you are a coach for athletes. How much would you weight the performance scores and how much would you let your judgment on the athlete motivation, youth, attitudes, listening skills, learning zeal…retain an athlete?

Every organization, institution, and decision-makers need to have a proper combination of analytic reasoning and data processing skills for models and split-second decision procedures.

Decisions not based first on understanding the trend of real data can be devastating.  And relying solely on data analysis would lead to many erroneous decisions…

Comprehensive knowledge, practice, experience…then allowing instinct to decide is “The power of thinking without thinking

Note 1: Post inspired from a chapter in “Blink” by Malcolm Gladwell

Note 2:




January 2021

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