How We Make Decisions - HOME - Bradford VTS



How We Make Decisions – Fast vs Slow Thinking SystemsBased on work by Daniel Kahneman who received the Nobel Prize in 2002 for his Dual Process Theory. Dual Process Theory says we have two thinking systems in our brains.System 1 = aka FAST Thinking System = helps us make fast decisions based on very few bits of information. System 2 = aka SLOW Thinking System = makes us slow down and deliberate before coming to a final decision.Which system is better?Neither. They are both important. For example, your about to cross the road, and suddenly you see a big lorry coming your way. You need the FAST system to help you make the FAST decision of stepping back to save your life. Employing the SLOWER System 2 thinking would be fatal here. In the medical setting, when you see the rash of meningitis – you need the fast system to make you rush for and give the benzylpenicillin injection. There’s no time for dithering.System 2, or the SLOW Thinking System, is needed for unfamiliar situations where you have the time to deliberate first to consider all your options so that you make the best decision possible. Clearly, in an emergency, you don’t have the time to do this. But there are many other life situations where there is. Let’s say you’re looking for a new home. You may have narrowed it down to four houses, but then you might ponder and think about the pros and cons of each over the following two weeks before making your decision. Hopefully, that decision you make would be a more suitable one than a decision made on the spur of the moment. In the medical setting, you may find that a patient keeps presenting again and again with the same problem despite having seen several doctors. This should make you stop, pause, reflect and SLOW DOWN – and use System 2 thinking to help you consider all the possibilities and decide what to do next. If you used System 1 FAST thinking in this situation, you would probably come to a rush diagnosis (perhaps like some of the doctors before) with fruitless results and a disappointed or even vexed patient (especially if it later turns out to be serious).So, what’s the problem?Far too often, doctors (like many professionals) are too keen on solving problems and in doing so, we sometime go for System 1 (FAST) thinking when we should be using System 2 (SLOW). For example, in the unfamiliar situation, rather than doing a comprehensive survey, we make decisions after collecting just a few bits of data. Instead, we should be slowing down, deliberating and considering great depths and breadths of data. We often let our first reactions (system 1) get in the way of making a decision. These ‘fast’ cognitive biases then lead us to making wrong decisions. Another example: Take the home visit request that comes in at 10 minutes before surgery closes. The computer screen says “Mrs Jones, pain in leg for several days”. Of course, it is annoying to get a home visit 10 minutes before home time! But that annoyance is the very thing that leads us to start pushing for a system 1 type reaction. As we dial the number we might thinking “she’s not getting a home visit for that” or “I’m sure it will be muscular” – and that’s before we’ve even gathered any data from her. Now, if we are thinking that way, the type of medical questions that we ask will tend to push towards a muscular diagnosis rather than truly considering on neutral territory all the possibilities – like cellulitis, DVT, ischaemic limb etc.What am I trying to say?We need to be careful of jumping to conclusions or relying on our ‘hunches’With familiar situations, just stop to pause and think for a moment to ensure you’ve considered alternatives.With the unfamiliar - check things out properly. Data gather comprehensively and triangulate pieces of evidence against other pieces of evidence. Look for themesAnd if some data is given to you which is at odds with other stuff, stop, breath, and review things for a moment. ................
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