Saturday, May 19, 2007

Decision-Making in the Blink of an Eye

Recently and quite inadvertently I picked up three different books pertaining either directly or indirectly with the workings of the mind and how human beings make decisions. In a recent post I alluded to the book Blink, which a friend recommended to me recently. Living in the so-called "Age of Information" as we do, we tend to follow the popular adage that the more information you have available at your fingertips to help you with decision-making, the better off you will be. In fact, all that extra information can be more than useless. In times of war or edical emergency, for example, that extra information can be fatal because it confuses the issues. The book is full of dozens of other examples of other costly misinterpretations of data.

But "extra information isn't actually an advantage at all... in fact, you need to know very little to find the underlying signature of a complex phenomena" (p. 136). Overloading decision-makers with information makes picking up that signature harder.

However, while intense scrutiny and analysis often leads one AWAY from an accurate assessment of any given situtation, "thin-slicing" the data by filtering out unnecessary informational parameters leads to a highly accurate diagnosis in an extremely short period of time-- figuratively speaking, not much longer than the blink of your eye. To be a successful decision-maker, you have to edit. Thin-slicing, i.e. recognizing patterns and making snap judgements, is how you do this process of editing unconsciously (p. 142).

When we talk about analytical versus intuitive decision making, neither is good or bad. What is good or bad is if you use either of them in an inappropriate circumstance (143-144). Of course, we have begun to do this in our society more and more often. How might we be doing this in our churches and on our mission fields? There, that's enough of an informational overload for you about this book.

Friday, May 18, 2007

A New Jewish Mother's Prayer

The prayer of a Jewish woman, who adopted a child from Vietnam who immediately got very sick, as told in the book How Doctors Think :

Dear Lord,
Having been created in Your image
I am full of unrealized potential
The realization of which
Depends upon my acknowledgment of the potential,
My recognition of all the gifts from You with which I am endowed,
And my exploitation of the opportunities that lie open before me.
Please Lord, help me rise to meet the challenge.
Let me use those gifts for the benefit of all people.
Dear Lord,
For all that I am
And all that I can be
I thank You.

The story of how this woman lived out her faith-- practicing what she prayed -- from chapter 5, A New Mother’s Challenge is well worth the read.

Thursday, May 17, 2007

How Doctors/Christian Workers Think

This week I’ve been reading How Doctors Think by Jerome Groopman, MD. Perhaps someone reading this post might want to write a book about How Christian Workers Think. I doubt it could make much money though! Please feel free to share your applications and comments related to the following tendencies as to how doctors think in relation to us as Christian workers:

1. The sickest patients can be the least liked by doctors:
Very sick people can even sense the disaffection that comes from their doctors… Physicians can be prone to a visceral sense of disgust when working with certain patients, especially those who do not appear to be taking care of themselves (e.g. alcoholics with cirrhosis or heavy smokers with end-stage emphysema, p. 45).

Doctors like healthier people more is because they have deep feelings of failure when dealing with diseases that resist even the best therapy; in such cases they become frustrated, because all their hard work seems like it’s for nothing. So they tend to want to put those who fall into that category out-of-sight and out-of-mind.

2.Doctors frame data selectively:
Medical students have in the back of their minds the goal of storing an encyclopedia in their minds, so that when they meet a patient they can open up a mental book and find the correct diagnosis and treatment right away. (p. 28) The instruction of clinical reasoning is such that medical students are taught to follow algorithms and practical guidelines.

As they gain experience, however, physicians tend to go with their first impressions. The initial biases in a physicians’ thinking are often reinforced by his selective survey of diagnostic data (p. 262). If these first impressions are dead-wrong, and other physicians follow them, then for patients with long histories there will be “cascades of cognitive errors.”

Most doctors quickly come up with two or three possible diagnoses from the outset of meeting a patient… They develop their hypothesis from a very incomplete body of information,” framing data very quickly, using shortcuts called heuristics. (p. 35) (For another interesting book that discusses how we thin-slice data in making quick judgments and how to improve in our decision-making ability, read the book Blink Here’s the amazon link or, like me, you can check it out at your public library!)

3. Doctors fall into cognitive traps:
Most of the time, doctors misdiagnose because they fall into cognitive traps, not because they have inadequate medical knowledge. “A growing body of research shows that technical errors account for only a small fraction of our incorrect diagnoses and treatments. Most errors are mistakes in thinking. (p. 40)

4. Emotions blur a doctor’s ability to listen and think:
And part of what causes these cognitive errors is our inner feelings, feelings we do not readily admit to and often don’t even recognize. (p. 40)

Medical decision-making is not an objective and rational process. The physician’s internal state, his state of tension, enters into and strongly influences his clinical judgments and actions. 36

For example, physicians who dislike their patients regularly cut them off during the recitation of symptoms and fix on a convenient diagnosis and treatment. “The doctor becomes increasingly convinced of the truth of his misjudgment developing a psychological commitment to it. He quickly becomes wedded (I think a better word might be welded!) to his distorted conclusion. His strong negative feelings about the patient make it harder for him to abandon that conclusion and reframe the clinical picture differently.” (Page 25)

Likewise, diagnoses are missed when physicians are overly attracted to their patients in positive ways. When a physician likes his patient, overly sympathizing with his or her pain, he or she can unconsciously hold back on certain tests or treatments which will cause the patient added suffering.

5. Good doctors learn from their mistakes:
A certain cardiologist kept a log of all the mistakes he knew he had made over the decades, and from time to time revisited this compendium when trying to figure out a particularly difficult case. “He was characterized by many of his colleagues as eccentric, an obsessive oddball. Only later did the author realize his implicit message to physicians was to admit our mistakes to ourselves, then analyze them, and keep them accessible at all times if we wanted to be stellar clinicians.” (p. 21)

Food for Thought for Christian Workers:
1. What factors out there predispose us to gravitate more to certain kinds of people? To what degree are we governed by “fear of failure” in how we approach our various missiological enterprises? Who are the people on our fields whom we more easily categorize as“out-of-sight out-of-mind”? How can we be more like our Great Physician in this regard?
2. How can we learn to more effectively and accurately "thin-slice"? What improper diagnoses do we tend to make early on with regard to the spiritual conditions of certain people?
3. Are we able to see past our emotions and preconceptions in decision-making, proactively engaging situations around us, etc? How do we go too far or not far enough in interacting with certain people because we like them or do not like them?
4. What cognitive traps are we prone to fall into that plague us for years down the road missiologically? How open are we to redirection?
5. Without dwelling too much on our pasts, are we reflecting upon our mistakes often enough?

Tuesday, May 15, 2007

Fishing for the Big One that Got Away

This week I’ve had the chance to fish for the first time in over five years (I don't fish in Taiwan; rather, I prefer skin-diving, as the waters there are like being inside a tropical salt water aquarium). Last night, while fishing from the Oregon Inlet Bridge in the Outer Banks of North Carolina, I hooked what felt like a very big one that pulled out on my drag for 5 or 10 seconds before breaking the line (and it was a fish and not just a skate!).

The near-desperate feeling of futility that came over me as another high tide was about to come and go without any catches resulted in some enjoyable back-and-forth banter with the Lord: “Lord, remember when you told the disciples where to throw down their nets? Remember how you arranged such an overwhelming catch for them? How about doing it for me just this once, Lord? And I don’t even have nets; all I care about is one fish.” Let's be honest: have any of you ever prayed a prayer like that?

Then of course I thanked Him because my relationship with Him was so much more important than catching that elusive big one, because He is the Maker of the sky, the sea, and the seabirds and fish and all else that fill them. And how I do not want my prayers to simply be attempts to manipulate Him, use Him, etc. like the prayers offered to gods overseas where I live often are....
耶和華啊!你是創造天地的主宰。我要讚美你。因為你曾經所說的:「水要滋長生物;地上和天空之中,要有雀鳥飛翔!」,跟我在海邊所經歷到的一模一樣。我自然而然肅然起敬。因為一草一木都是因為你而存在的。「耶和華啊!不要把榮耀歸給我們,不要歸給我們;要因你的慈愛和信實把榮耀歸在你的名下。」(詩1151 Nevertheless I would have been happy had He chosen to answer the prayer! :-)

Along these lines, this morning while reading an online A.W. Tozer RSS feed, I read the following very appropriate thought: “Whoever seeks God as a means toward desired ends will not find God. God will not be one of many treasures. His mercy and grace are infinite and His patient understanding is beyond measure, but He will not aid men in selfish striving after personal gain. If we love God as much as we should, surely we cannot dream of a loved object beyond Him which He might help us to obtain!”

By the way, I did land a very modest 14 inch bluefish before calling it quits last night.