Burnout in Medicine - Dr Frieschlag advice on thriving and surviving in medicine

Thanks Dr Freischlag for the recent post in Linkedin "bloom where you're planted: surviving and thriving in a medical career.
(https://www.linkedin.com/pulse/bloom-where-youre-planted-surviving-thriving-medical-freischlag?trk=prof-post)
      This provides a nice framework for young professionals and a turning point for us older professionals to reflect and act upon.
      Burnout amongst high stress professionals is not uncommon no matter what the profession. I recently assessed what  burnout meant with other professions to understand why physicians are so prone to burnout.
      Article on banking- "What makes for such an elongated burnout zone? Michel’s research found that burnout rises as bankers hit their mid-20s. At this stage, she said it becomes obvious that they can’t keep pushing themselves so hard: the bankers she studied “developed embarrassing tics, such as nail biting, nose picking, or hair twirling.” Thereafter, however, things are supposed to get better – after six years in the industry Michel’s bankers took better care of themselves. They learned that this was the only way to survive."
   Burnout in law- "Law can be a very stressful profession.  Frequently there are long hours and demanding bosses and clients.  If a lawyer makes a mistake there is always the risk of a malpractice claim hanging over his head.  Some areas of practice are very emotional, and that can be difficult.  "
         So long hours and the threat of a suit seem to be a universal risk for burnout in most professions.
         The posts here and elsewhere highlight problems we healthcare professionals all face that supercede long hours, risk of lawsuit or loss of professional character as faced by all high risk professionals -
In addition to those risk factors, healthcare professionals risk:
..Losing control over provision of what we feel is appropriate care to our patients to third parties
... And Loss /injury of a patient
Let's face it -we can be sued, be humiliated, or lose a job and move on, but none of us can just "get over" a loss or injury to a patient due to third party oversight or error!! It's impossible. Unfortunately, we do not do a great job at developing mentorship groups to understand ahead of time how to manage those things we actually have control over and how to cope when things do not turn out ideally. We are afraid to talk about it and frequently told to NOT talk about it. Worse of all is that organizations focus on and punish those who committed this or that error rather than assessing how do we teach risk / error prevention and management or how to communicate/ function as a team.
We can do better.
Kenneth A. Lipshy, MD, FACS
www.crisismanagementleadership.com

Burnout in Medicine - Dr Freischlag advice on thriving and surviving in medicine

Thanks Dr Freischlag for the recent post in Linkedin "bloom where you're planted: surviving and thriving in a medical career.
(https://www.linkedin.com/pulse/bloom-where-youre-planted-surviving-thriving-medical-freischlag?trk=prof-post)
      This provides a nice framework for young professionals and a turning point for us older professionals to reflect and act upon.
      Burnout amongst high stress professionals is not uncommon no matter what the profession. I recently assessed what  burnout meant with other professions to understand why physicians are so prone to burnout.
      Article on banking- "What makes for such an elongated burnout zone? Michel’s research found that burnout rises as bankers hit their mid-20s. At this stage, she said it becomes obvious that they can’t keep pushing themselves so hard: the bankers she studied “developed embarrassing tics, such as nail biting, nose picking, or hair twirling.” Thereafter, however, things are supposed to get better – after six years in the industry Michel’s bankers took better care of themselves. They learned that this was the only way to survive."
   Burnout in law- "Law can be a very stressful profession.  Frequently there are long hours and demanding bosses and clients.  If a lawyer makes a mistake there is always the risk of a malpractice claim hanging over his head.  Some areas of practice are very emotional, and that can be difficult.  "
         So long hours and the threat of a suit seem to be a universal risk for burnout in most professions.
         The posts here and elsewhere highlight problems we healthcare professionals all face that supercede long hours, risk of lawsuit or loss of professional character as faced by all high risk professionals -
In addition to those risk factors, healthcare professionals risk:
..Losing control over provision of what we feel is appropriate care to our patients to third parties
... And Loss /injury of a patient
Let's face it -we can be sued, be humiliated, or lose a job and move on, but none of us can just "get over" a loss or injury to a patient due to third party oversight or error!! It's impossible. Unfortunately, we do not do a great job at developing mentorship groups to understand ahead of time how to manage those things we actually have control over and how to cope when things do not turn out ideally. We are afraid to talk about it and frequently told to NOT talk about it. Worse of all is that organizations focus on and punish those who committed this or that error rather than assessing how do we teach risk / error prevention and management or how to communicate/ function as a team.
We can do better.
Kenneth A. Lipshy, MD, FACS
www.crisismanagementleadership.com

MANDATED SURGEON WORK HOUR RESTRICTIONS- YEAH OR NAH?

MANDATED SURGEON WORK HOUR RESTRICTIONS- YEAH OR NAH?

The debate of mandatory Surgeon work hour restrictions seems to recycle more and more. The opinions range from a demand for regulation of work hours to “"Just from me and probably for my own reasons- I have never understood, nor agreed with these kind of comments about fatigue, burnout, stress, etc. Stress is the pablum of productivity. Bordom produces mediocrity.” The recent ACS  community post on this subject brings back several conversations I have had over the past year.

In August 2015, Dr. Carlos Pellegrini, reissued a consensus statement for the American College of Surgeons on “addressing surgeon fatigue and sleep deprivation”. Here he conceded that the evidence regarding sleep deprivation in health care is equivocal at the moment, but advised “I believe a balanced and reasonable approach is needed in addressing this issue.” In this statement he implored surgeons to partner with their Health Care enterprises to work out a viable solution based on sound judgment. He expressed to me the need to for us to be able to simultaneously assure there are surgeons available to our institutions and to provide “support for institutions and systems supporting surgeons who believe they are tired”.   In addition, he and I discussed via email the fact that measuring sleep deprivation in surgeons is difficult at best due to no effective means of measuring the sleep character of surgeons who are not on call and theoretically getting a good night’s sleep (i.e. what other stressors occurred causing a restless night or fatigue).

Later in August 2015 Dr. Nancy Baxter’s group (from Toronto) published in NEJM their results of a review of procedures whereby Surgeons were at the hospital seeing patients between the hours of Midnight to 7am and subsequently performed major operations during dayshift the rest of that day, with no significant morbidity or mortality compared to surgeons doing the same operations but without working during that 7 hour window. This paper has been grossly misquoted all across the internet. Fortunately, Dr. Baxter was gracious to discuss this paper with me. She clarified that their group concluded that “sleep loss resulting from the provision of overnight medical care did not measurably affect the short-term outcomes of elective procedures performed the next day.” Next they stated that “broad-based policy shifts in duty hours may not be necessary..” But most of all she clearly states that “the effect of profound sleep loss may warrant further study AND it remains important for physicians to critically assess the effects of ALL sources of fatigue…” She pointed out to me that to their group, the entire spectrum of issues that affect our ability to care for patients should be assessed more fully before we institute blanket policies. A surgeon who is not up performing patient care the night before may be more stressed over other issues and sleep less soundly than one who was up all night. Likewise, a surgeon who was up at night prior to a day in the OR may actually find his awareness and acuity has been heightened for the first 6 hours of the day and then exhausted at the end of the day when no further patient care is required. As we discussed, there is undoubtedly a given degree of sleep deprivation that will cause decrease effectiveness in decision making and manual skills in the field of surgery, but it does not appear to be a static period of time, as it likely varies with other physical and mental factors of the physician, the type of care being provided the night prior, the type of care being provided the following day and the total length of wakefulness. Driving a car after being up all night and working all day is a boring tedious task and has been shown by several to be dangerous (at least in residents, per Tan), but does that necessarily translate to being dangerous in the OR?  Distractions in the Operating room are not a minor matter but, as Ann Wheelock and I discussed this Summer, are very serious and can completely impact the potential for error and injury during a procedure.

Shortly after that conversation I was fortunate to have Dale Roberts (Air Transportation Division, flight standards service, FAA), Tom Nesthus, Chester Piolunek (Aviation Safety Inspector AFS-220, Air Carrier Operations Branch) and Steve Hursh talk to me. They all run, work for or advise the FAA Pilot Sleep Deprivation Protocol Program. (Turns out that Dale Roberts has a wife who is a nurse so he has first-hand knowledge how medical professionals work in sleep deprived conditions.) We discussed things currently in use in aviation including the PVT (Pilot psychomotor vigilance task test), use of actigraphs, alternatives to mandatory restrictive rules including the use of split duties and naps (the FAA states they recommend these be used by pilots who are on long flight patterns and would otherwise not be able to conform to mandatory restrictions- but pilots say all they do is “look at their partners eyes to see if they are ok to go on”) and other thoughts on measuring sleep deprivation and methods to overcome this in a reasonable process. The FAA has some data on pilot fatigue but draws a lot of their research from other fields.

Then in October 2015 a panel discussion covering Sleep was presented at the ACS Clinical congress. I will not rehash that meeting but want to bring up a concern by a surgeon in rural practice. He had a partner but found himself enduring 2 years of the only surgeon on call over 280 nights per year and when he said he was not on call, if he refused to come in, he was being threatened with EMTALA violations by other hospitals and the staff at his hospital.

Dr Pellegrini cautions us against taking sleep deprivation and its effect on fatigue and concentration lightly. He reminded me that sleep deprivation will eventually diminish concentration and skill in any professional. He also reminded me that studies that refute this tend to highlight short term outcomes, but what about long-term outcomes (i.e. Cancer recurrence) when we operate after a sleep deprived night? It is clear, that fatigue, sleep deprivation and other stressors make any professional distracted and error prone at some point. At what point that occurs is what surgeons need to be at the forefront in defining. We simply cannot allow any outside agency to make that determination for us.


Kenneth A. Lipshy, MD, FACS
www.crisismanagementleadership.com

•                Govindarajan A, Urbach DR, Kumar MM, Murray BJ,  Juurlink D, Kennedy E,  Gagliardi A, Sutradhar R,  Baxter NN. Outcomes of Daytime Procedures Performed by Attending Surgeons after Night Work. N Engl J Med 2015; 373:845-853

• The American College of Surgeons. Pellegrini CA. Addressing surgeon fatigue and sleep deprivation. Bull Am Coll Surg.2015;100(8):72-74.

• The American College of Surgeons. Statement on peak performance and management of fatigue. Bull Am Coll Surg.2014;99(8):53-54. Available at: bulletin.facs.org/2014/08/statement-on-peak-performance-and-management-of-fatigue/. Accessed Sept 18, 2015.

• Sexton JB, Thomas EJ, Helmreich RL. Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ. March 2000;320(7237): 745–749.

•           FAA Fact Sheet – Pilot Fatigue; http://www.faa.gov/news/fact_sheets/news_story.cfm?newsId=11857

• NTSB: Loss of Control on Approach Colgan Air, Inc. Operating as Continental Connection Flight 3407 Bombardier DHC-8-400, N200WQ Clarence Center, New York
  http://www.ntsb.gov/investigations/AccidentReports/Reports/AAR1001.pdf#page=176

• Roehrs T; Burduvali E; Bonahoom A et al. Ethanol and sleep loss: a “dose” comparison of impairing effects Sleep 2003; 26(8):981-5.

• Nurok M, Czeisler CA, Lehmann S. Sleep Deprivation, Elective Surgical Procedures, and Informed Consent. N Engl J Med 2010; 363:2577-2579.

• Rothschild JM, Keohane CA, Rogers S, et al. Risks of complications by attending physicians after performing nighttime procedures. JAMA2009;302:1565-1572

• Tsafrir Z, Korianski J, Almog B,  Many A, Wiesel O, Levin I. Effects of Fatigue on Residents’ Performance in Laparoscopy Jnl Am Col Surg 2015; 221(2):564-570

• Tan SY. http://www.acssurgerynews.com/opinions/single-view/auto-accidents-in-sleepy-medical-trainees/df2feb72ed99e926cdbb76f3d9c12d4b.html

MANDATED SURGEON WORK HOUR RESTRICTIONS- YEAH OR NAH?

MANDATED SURGEON WORK HOUR RESTRICTIONS- YEAH OR NAH?

The debate of mandatory Surgeon work hour restrictions seems to recycle more and more. The opinions range from a demand for regulation of work hours to “"Just from me and probably for my own reasons- I have never understood, nor agreed with these kind of comments about fatigue, burnout, stress, etc. Stress is the pablum of productivity. Bordom produces mediocrity.” The recent ACS  community post on this subject brings back several conversations I have had over the past year.

In August 2015, Dr. Carlos Pellegrini, reissued a consensus statement for the American College of Surgeons on “addressing surgeon fatigue and sleep deprivation”. Here he conceded that the evidence regarding sleep deprivation in health care is equivocal at the moment, but advised “I believe a balanced and reasonable approach is needed in addressing this issue.” In this statement he implored surgeons to partner with their Health Care enterprises to work out a viable solution based on sound judgment. He expressed to me the need to for us to be able to simultaneously assure there are surgeons available to our institutions and to provide “support for institutions and systems supporting surgeons who believe they are tired”.   In addition, he and I discussed via email the fact that measuring sleep deprivation in surgeons is difficult at best due to no effective means of measuring the sleep character of surgeons who are not on call and theoretically getting a good night’s sleep (i.e. what other stressors occurred causing a restless night or fatigue).

Later in August 2015 Dr. Nancy Baxter’s group (from Toronto) published in NEJM their results of a review of procedures whereby Surgeons were at the hospital seeing patients between the hours of Midnight to 7am and subsequently performed major operations during dayshift the rest of that day, with no significant morbidity or mortality compared to surgeons doing the same operations but without working during that 7 hour window. This paper has been grossly misquoted all across the internet. Fortunately, Dr. Baxter was gracious to discuss this paper with me. She clarified that their group concluded that “sleep loss resulting from the provision of overnight medical care did not measurably affect the short-term outcomes of elective procedures performed the next day.” Next they stated that “broad-based policy shifts in duty hours may not be necessary..” But most of all she clearly states that “the effect of profound sleep loss may warrant further study AND it remains important for physicians to critically assess the effects of ALL sources of fatigue…” She pointed out to me that to their group, the entire spectrum of issues that affect our ability to care for patients should be assessed more fully before we institute blanket policies. A surgeon who is not up performing patient care the night before may be more stressed over other issues and sleep less soundly than one who was up all night. Likewise, a surgeon who was up at night prior to a day in the OR may actually find his awareness and acuity has been heightened for the first 6 hours of the day and then exhausted at the end of the day when no further patient care is required. As we discussed, there is undoubtedly a given degree of sleep deprivation that will cause decrease effectiveness in decision making and manual skills in the field of surgery, but it does not appear to be a static period of time, as it likely varies with other physical and mental factors of the physician, the type of care being provided the night prior, the type of care being provided the following day and the total length of wakefulness. Driving a car after being up all night and working all day is a boring tedious task and has been shown by several to be dangerous (at least in residents, per Tan), but does that necessarily translate to being dangerous in the OR?  Distractions in the Operating room are not a minor matter but, as Ann Wheelock and I discussed this Summer, are very serious and can completely impact the potential for error and injury during a procedure.

Shortly after that conversation I was fortunate to have Dale Roberts (Air Transportation Division, flight standards service, FAA), Tom Nesthus, Chester Piolunek (Aviation Safety Inspector AFS-220, Air Carrier Operations Branch) and Steve Hursh talk to me. They all run, work for or advise the FAA Pilot Sleep Deprivation Protocol Program. (Turns out that Dale Roberts has a wife who is a nurse so he has first-hand knowledge how medical professionals work in sleep deprived conditions.) We discussed things currently in use in aviation including the PVT (Pilot psychomotor vigilance task test), use of actigraphs, alternatives to mandatory restrictive rules including the use of split duties and naps (the FAA states they recommend these be used by pilots who are on long flight patterns and would otherwise not be able to conform to mandatory restrictions- but pilots say all they do is “look at their partners eyes to see if they are ok to go on”) and other thoughts on measuring sleep deprivation and methods to overcome this in a reasonable process. The FAA has some data on pilot fatigue but draws a lot of their research from other fields.

Then in October 2015 a panel discussion covering Sleep was presented at the ACS Clinical congress. I will not rehash that meeting but want to bring up a concern by a surgeon in rural practice. He had a partner but found himself enduring 2 years of the only surgeon on call over 280 nights per year and when he said he was not on call, if he refused to come in, he was being threatened with EMTALA violations by other hospitals and the staff at his hospital.

Dr Pellegrini cautions us against taking sleep deprivation and its effect on fatigue and concentration lightly. He reminded me that sleep deprivation will eventually diminish concentration and skill in any professional. He also reminded me that studies that refute this tend to highlight short term outcomes, but what about long-term outcomes (i.e. Cancer recurrence) when we operate after a sleep deprived night? It is clear, that fatigue, sleep deprivation and other stressors make any professional distracted and error prone at some point. At what point that occurs is what surgeons need to be at the forefront in defining. We simply cannot allow any outside agency to make that determination for us.


Kenneth A. Lipshy, MD, FACS
www.crisismanagementleadership.com

•                Govindarajan A, Urbach DR, Kumar MM, Murray BJ,  Juurlink D, Kennedy E,  Gagliardi A, Sutradhar R,  Baxter NN. Outcomes of Daytime Procedures Performed by Attending Surgeons after Night Work. N Engl J Med 2015; 373:845-853

• The American College of Surgeons. Pellegrini CA. Addressing surgeon fatigue and sleep deprivation. Bull Am Coll Surg.2015;100(8):72-74.

• The American College of Surgeons. Statement on peak performance and management of fatigue. Bull Am Coll Surg.2014;99(8):53-54. Available at: bulletin.facs.org/2014/08/statement-on-peak-performance-and-management-of-fatigue/. Accessed Sept 18, 2015.

• Sexton JB, Thomas EJ, Helmreich RL. Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ. March 2000;320(7237): 745–749.

•           FAA Fact Sheet – Pilot Fatigue; http://www.faa.gov/news/fact_sheets/news_story.cfm?newsId=11857

• NTSB: Loss of Control on Approach Colgan Air, Inc. Operating as Continental Connection Flight 3407 Bombardier DHC-8-400, N200WQ Clarence Center, New York
  http://www.ntsb.gov/investigations/AccidentReports/Reports/AAR1001.pdf#page=176

• Roehrs T; Burduvali E; Bonahoom A et al. Ethanol and sleep loss: a “dose” comparison of impairing effects Sleep 2003; 26(8):981-5.

• Nurok M, Czeisler CA, Lehmann S. Sleep Deprivation, Elective Surgical Procedures, and Informed Consent. N Engl J Med 2010; 363:2577-2579.

• Rothschild JM, Keohane CA, Rogers S, et al. Risks of complications by attending physicians after performing nighttime procedures. JAMA2009;302:1565-1572

• Tsafrir Z, Korianski J, Almog B,  Many A, Wiesel O, Levin I. Effects of Fatigue on Residents’ Performance in Laparoscopy Jnl Am Col Surg 2015; 221(2):564-570

• Tan SY. http://www.acssurgerynews.com/opinions/single-view/auto-accidents-in-sleepy-medical-trainees/df2feb72ed99e926cdbb76f3d9c12d4b.html

Natural Decision Making under duress: a Conversation with Gary Klein

Natural Decision Making under duress: a Conversation with Gary Klein

My understanding of decision making under pressure, from reading the works of Gary Klein (GK) and Sayra Cristancho, is that one gathers sensory input that they hopefully utilize to trigger a memory (from experience in the field or in training) of something familiar that creates a story as Paul Van Riper says. I tend to visualize it as a mental map whereby I use familiar landmarks similar to driving or walking somewhere. We use landmarks that are either familiar to us by past experience or through research to get from one place to the other. All this is subconscious and done fairly instantaneous if we are successful. It is highly subjected to heuristics / bias so how can we improve this? What makes one person excellent and another poor at this process of problem detection? I decided to go straight to the source for that.
1.    Is Photographic memory a necessity? That is if we don’t recall in pictures, how can one create that story and then simulate in our head if our interpretation is correct and if our action will be successful?
GK: “I would hope not. Most people do not have a photographic memory but most can do this well. Photographic memory does not have a lot to do with this… It is a snapshot of what is there. I have not seen this before… If this relied on photographic memory you would have to shift thru all the photographs in your memory. What appears to happen seems to be that people develop buckets of prototypes. If the situation does not fit the buckets then they need detect familiarity or non-familiarity. You need natural experience- prototypes. If it does not fit, some try to force it into a bucket, but if you have been burned before, then you become alert to those features and assess further.”
2.    Is IQ a factor? If I have a high IQ, is this faster? Is this a product of Fluid intelligence or Crystalized intelligence?
GK: “IQ does have an influence if you look at the whole range of IQ variability but in medicine there is a lower range for IQ. That is you have selected out for a higher IQ in that population.” “For that matter, what is the IQ range of Surgeons, SEALS… do we have any study to tell us”. “It’s like playing poker (five card draw), you have to have Jacks or better. In 5 card draw, you cannot open w/o jacks or better, but you may not win. You may not even bet.”
3.    If we practice using clues to solve problems in daily life do we get better, i.e. When I used to use a map to get from one place to another was I better off at problem resolution than now when I use Siri all the time- am I getting dumber?
GK: “we may not be getting dumber, but we are not using navigation skills. I used to use a GPS system to get to and from a place that was 30min out. It took me a while to realize that I had no idea how to get there. Before I used a map and had a clear notion and I had an ability to change course if there was a problem in the route I had chosen. Now I had no idea what to do if something was blocking my way. As we use this technology we are losing these skills. Soldiers using GPS have map skill erosion. I don’t remember phone numbers now.”
Does this deteriorate our problem solving ability- sign detection? GK “we are getting lazy, not losing the ability to recognize signs but we are becoming passive. I wrote a chapter about this in POWER OF INTUITION, on smart machines making us stupid.” How do we get people up to speed faster?
GK “I hear the same complaint in police, nursing, medical school… people come out and on paper they are qualified but they lack the judgment skills needed and it will take a few years to bridge that gap”. “probably not spending the same hours per week. ”
ME: We had books, not phones and we had to carry our knowledge in our heads or on cards, not on the phone.
GK “We had photocopy machines and could not take out the article from the library so in the 60s we had to remember everything.”
4.    Since he understands this process how does he train to avoid missing the gorilla in front of him.
GK: “I am not training myself like a firefighter or military leader or physician trains their self as a first responder. I am now trying to identify the practices people engage in. Scenario exercises to train these responders. Our company is designing scenario based decision training”. We teach the Shadowbox method.”


Kenneth A. Lipshy, MD, FACS
www.crisismanagementleadership.com

Natural Decision Making under duress: a Conversation with Gary Klein

Natural Decision Making under duress: a Conversation with Gary Klein

My understanding of decision making under pressure, from reading the works of Gary Klein (GK) and Sayra Cristancho, is that one gathers sensory input that they hopefully utilize to trigger a memory (from experience in the field or in training) of something familiar that creates a story as Paul Van Riper says. I tend to visualize it as a mental map whereby I use familiar landmarks similar to driving or walking somewhere. We use landmarks that are either familiar to us by past experience or through research to get from one place to the other. All this is subconscious and done fairly instantaneous if we are successful. It is highly subjected to heuristics / bias so how can we improve this? What makes one person excellent and another poor at this process of problem detection? I decided to go straight to the source for that.
1.    Is Photographic memory a necessity? That is if we don’t recall in pictures, how can one create that story and then simulate in our head if our interpretation is correct and if our action will be successful?
GK: “I would hope not. Most people do not have a photographic memory but most can do this well. Photographic memory does not have a lot to do with this… It is a snapshot of what is there. I have not seen this before… If this relied on photographic memory you would have to shift thru all the photographs in your memory. What appears to happen seems to be that people develop buckets of prototypes. If the situation does not fit the buckets then they need detect familiarity or non-familiarity. You need natural experience- prototypes. If it does not fit, some try to force it into a bucket, but if you have been burned before, then you become alert to those features and assess further.”
2.    Is IQ a factor? If I have a high IQ, is this faster? Is this a product of Fluid intelligence or Crystalized intelligence?
GK: “IQ does have an influence if you look at the whole range of IQ variability but in medicine there is a lower range for IQ. That is you have selected out for a higher IQ in that population.” “For that matter, what is the IQ range of Surgeons, SEALS… do we have any study to tell us”. “It’s like playing poker (five card draw), you have to have Jacks or better. In 5 card draw, you cannot open w/o jacks or better, but you may not win. You may not even bet.”
3.    If we practice using clues to solve problems in daily life do we get better, i.e. When I used to use a map to get from one place to another was I better off at problem resolution than now when I use Siri all the time- am I getting dumber?
GK: “we may not be getting dumber, but we are not using navigation skills. I used to use a GPS system to get to and from a place that was 30min out. It took me a while to realize that I had no idea how to get there. Before I used a map and had a clear notion and I had an ability to change course if there was a problem in the route I had chosen. Now I had no idea what to do if something was blocking my way. As we use this technology we are losing these skills. Soldiers using GPS have map skill erosion. I don’t remember phone numbers now.”
Does this deteriorate our problem solving ability- sign detection? GK “we are getting lazy, not losing the ability to recognize signs but we are becoming passive. I wrote a chapter about this in POWER OF INTUITION, on smart machines making us stupid.” How do we get people up to speed faster?
GK “I hear the same complaint in police, nursing, medical school… people come out and on paper they are qualified but they lack the judgment skills needed and it will take a few years to bridge that gap”. “probably not spending the same hours per week. ”
ME: We had books, not phones and we had to carry our knowledge in our heads or on cards, not on the phone.
GK “We had photocopy machines and could not take out the article from the library so in the 60s we had to remember everything.”
4.    Since he understands this process how does he train to avoid missing the gorilla in front of him.
GK: “I am not training myself like a firefighter or military leader or physician trains their self as a first responder. I am now trying to identify the practices people engage in. Scenario exercises to train these responders. Our company is designing scenario based decision training”. We teach the Shadowbox method.”


Kenneth A. Lipshy, MD, FACS
www.crisismanagementleadership.com

Pattern Recognition and Critical thinking- A Call with Leading Critical Thinker, Pat Croskerry

Pattern Recognition and Critical thinking- A Call with Leading Critical Thinker, Pat Croskerry

Previously, I had the pleasure of talking with Pat Croskerry MD, PhD, FRCP(Edin); Professor, Department of Emergency Medicine, Director, Critical Thinking Program, Division of Medical Education, Dalhousie University, Halifax, Nova Scotia, CANADA. He was gracious to explain critical thinking and its importance in pattern recognition during our day to day life.

 It is clearly a subject I had no real basis of understanding in, and his explanation made it sound so very simple. It is clear that we tend to focus on the trees and not the forest most of the time. This inevitably could prevent our recognizing that something bad is going to or already has happened. His work with emergency medicine in looking at what we are doing in a different light has taught many to avoid common errors. By developing this critical thinking we are allowing ourselves to train to assess all the input coming our way and deciding if there is a potential for a problem or not. Experts can do this without clouding their routine or slowing themselves down, but clearly this take practice.
Kenneth A. Lipshy, MD, FACS
www.crisismanagementleadership.com