[Music]
I would like to tell you about my nephew
when he was three years old he was sick
and dehydrated and he was admitted to
the hospital with diagnosis stomach flu
which is a common ailment for toddlers
yet he did not get better after nine
days my nephew had an MRI scan his
parents my brother and my sister-in-law
were waiting outside and all of a sudden
they saw a medical specialist
approaching they were running and
entering the door of the room where my
nephew wasn’t it lying in the MRI scan
my brother physically remembers the way
the white coats were flapping after them
as they entered the door I nephew had a
brain abscess and the size of his brain
abscess was five centimeter this painful
family history raised my interest in
cognitive error in medicine because all
of a sudden I realized that physicians
that they make decisions all the time
that you could say that making decisions
is about the core of being a physician
and yes I can tell from my own
experience that we are barely educated
in decision making or in recognizing
cognitive error I myself am now in the
position to develop Bachelor education
for medical students and I try to pay
attention to cognitive error and
decision-making in my teaching I’ve once
taught with a professor in surgery which
I thought was really cool and together
we discussed with the students how
lifestyle factors or occupational
factors can make you more prone to
making cognitive errors factors such as
stress or lack of sleep or time pressure
or peer pressure and I think it’s it’s
rather impactful when
since surgery says well you know it’s
not cool to sleep only three or four
hours a day you should have seven at
least I think we as public enter
operational health professionals can
play a major role in identifying these
factors and then changing the system in
order to make medicine safer and better
but I chose not to focus on that task
here it would be a bit too easy I
thought and it might make us prone to
well collectively become victim of the
blind spot bias the cognitive error
which well says that people are always
more sensitive to other people as other
people’s errors than their own instead I
would like to go into the question here
what is it that we as public health
professionals can learn from the
research on decision making and on
cognitive error first I will give some
background information these fields of
research is things distinguishes two
systems of thought conveniently called
system 1 and system 2 and also elevates
about those and while this information
is very easily found in Daniel Kahneman
book Thinking Fast and Slow and then I
will apply this knowledge to public
health system one system one is the
oldest system from an evolutionary point
of view we share it with animals if we
see a large spider we withdraw that
system one if we see an angry face we
think are better avoid that or if we
recognize someone in the audience then
we become happy system one helps us
through the day and it guides most of
our decisions and responses it works
continuously it works fast it works
without effort and without conscious
control and it’s one more thing that I
would like to point out about system 1
here is that it loves good stories good
stories about in the
your cases now a system to system two is
the very human system it’s it’s rational
conscious thinking and it’s active when
we are doing mathematics or when we are
making a difficult maneuver with our
cars it’s much younger than system one
from an evolutionary point of view and
well it doesn’t work that easily yet you
need to switch it on consciously it
works slow slowly it takes a lot of
energy to use system too and it often
feels hard like I’m thinking that’s
failing and now on to public health one
way to apply the knowledge on system 1
and system 2 on public health would be
how should we handle ourselves as public
health professionals but first I will
focus on the question how should we
address the general public well when we
address the public general public as
public health professionals we often
provide good information and then we
actually focus on the public system too
we say things like Anna I quote from a
general website anything that influences
the likelihood of developing diabetes or
of worsening the condition also
increases the chances of dying from the
condition well this is a very system to
sentence can people understand chances
and statistics this has been
investigated and yes they can they can
understand statistic data they are able
to believe statistic data they can be so
surprised about statistic data that they
go out and tell their friends about it
so by then system 2 is definitely
convinced and yet if it’s the statistic
data do not match beliefs people already
has floating about in their system one
then they will not change those beliefs
and these beliefs are intimate they are
about self about your life about the
people you love so nothing will change
because system one is the system that
gets us through the day now how can we
reach system one as well
it’s fairly easy actually you can reach
it by a surprising and emotional story
experience or event about one single
case I have two examples well first my
own standing here is due to the
surprising and emotional case of my
nephew it changed the way I see my
profession and it got me reading and and
learning and teaching even so that’s a
change I think and another example might
be that’s when the US public was asked
you know in research to estimate the
frequency of different causes of death
the public thought that deaths by car
accidents is 300 times more frequent
than deaths by diabetes well if we
imagine the state of the US public then
we know that this can’t be true the
problem here is that well in the
collective mind people stores have so
many stories stored about well single
cases of car accidents stories that are
fearful and emotional and they legs they
lack stories vivid and emotional stories
of death by diabetes I think that we as
public health professionals have to
connect deaths by diabetes that’s
abstract concepts to individual faces
and to individual stories
not to scare the public but because
people have the right to receive useful
information information that changes
beliefs and that promotes action well
and that in short would be information
about individual cases now on to my next
topic what can we as public health
professionals learn for ourselves from
research on decision and error I would
like to propose here that we make a
conscious effort to employ system to
while we are doing our job and I will
focus here on the tension between
coherence and ambivalence system one
with its law for good stories
it’s very formed of coherence of stories
that match fluid easy thinking just goes
on and it does not like ambivalence it
could be there so it could be that it
doesn’t like doubt or uncertainty we as
human beings need system to to doubt and
we need system to to ensure ambivalence
I think that we as public health
professionals have to be experts in
actively tolerating ambivalence we often
work with people with as we call it bad
lifestyles they have bad eating habits
or bad habits in smoking and drinking
and still we have to be able to look
beyond the bad lifestyle we have to be
able to connect with the strengths of
these people and to activate a sense of
human dignity
this may sound it’s the normal and
obvious thing to do but unfortunately in
in real life it can be a struggle to
keep this ambivalence alive bad
lifestyle good people especially if a
public health professional is already
well over burdens or exhausted
I’ve got another example a very
sensitive topic the detection of child
abuse when I myself worked as a per well
child care physician I noticed how
difficult this task is I often liked the
people the parents that were sitting in
front of me and yet sometimes I really
had to have suspected of child abuse and
it was difficult to tolerate this
ambivalence nice people bad things and
perhaps it even made me having to
tolerate the idea that I myself while
being nice would also be able to do bad
things now if we as public health
professionals do suspect a case of child
abuse we never know what the outcome
will be
it’s terribly uncertain this situation
and your your whole system one is
screaming at you there’s ambivalence
here there’s danger we should withdraw
and avoid quick and yet we have to
persist we have to do our job
to conclude I hope have shown that
knowledge on decision making and
cognitive error is useful in prevention
and public health and I proposed here to
pay attention to the system one of our
clients and to the system – of ourselves
I’ve plead to dive into storytelling and
into ambivalence I started out with the
story of my nephew and I’m very happy to
tell you that this story ends well
despite this orange sized hole in his
brains he recovered in an amazing manner
he’s 6 years old now and goes through a
regular school adult brain would not be
that’s flexible but still I would like
to end here with the idea that we too
have to use our brain plasticity we have
to keep on learning
since this this would be my final and
more hidden goal this TED talk to
demonstrate the value of connecting
public health to other fields of
research and knowledge public health
offers such benefits to society and yet
it can also be so difficult to get
results I think that we owe it to
society to collectively harvest whatever
useful knowledge there is out there from
other fields of research in that way we
can become as effective as possible and
as a useful by effect we train our
system to to the max thank you for your
attention
[Music] you
I would like to tell you about my nephew
when he was three years old he was sick
and dehydrated and he was admitted to
the hospital with diagnosis stomach flu
which is a common ailment for toddlers
yet he did not get better after nine
days my nephew had an MRI scan his
parents my brother and my sister-in-law
were waiting outside and all of a sudden
they saw a medical specialist
approaching they were running and
entering the door of the room where my
nephew wasn’t it lying in the MRI scan
my brother physically remembers the way
the white coats were flapping after them
as they entered the door I nephew had a
brain abscess and the size of his brain
abscess was five centimeter this painful
family history raised my interest in
cognitive error in medicine because all
of a sudden I realized that physicians
that they make decisions all the time
that you could say that making decisions
is about the core of being a physician
and yes I can tell from my own
experience that we are barely educated
in decision making or in recognizing
cognitive error I myself am now in the
position to develop Bachelor education
for medical students and I try to pay
attention to cognitive error and
decision-making in my teaching I’ve once
taught with a professor in surgery which
I thought was really cool and together
we discussed with the students how
lifestyle factors or occupational
factors can make you more prone to
making cognitive errors factors such as
stress or lack of sleep or time pressure
or peer pressure and I think it’s it’s
rather impactful when
since surgery says well you know it’s
not cool to sleep only three or four
hours a day you should have seven at
least I think we as public enter
operational health professionals can
play a major role in identifying these
factors and then changing the system in
order to make medicine safer and better
but I chose not to focus on that task
here it would be a bit too easy I
thought and it might make us prone to
well collectively become victim of the
blind spot bias the cognitive error
which well says that people are always
more sensitive to other people as other
people’s errors than their own instead I
would like to go into the question here
what is it that we as public health
professionals can learn from the
research on decision making and on
cognitive error first I will give some
background information these fields of
research is things distinguishes two
systems of thought conveniently called
system 1 and system 2 and also elevates
about those and while this information
is very easily found in Daniel Kahneman
book Thinking Fast and Slow and then I
will apply this knowledge to public
health system one system one is the
oldest system from an evolutionary point
of view we share it with animals if we
see a large spider we withdraw that
system one if we see an angry face we
think are better avoid that or if we
recognize someone in the audience then
we become happy system one helps us
through the day and it guides most of
our decisions and responses it works
continuously it works fast it works
without effort and without conscious
control and it’s one more thing that I
would like to point out about system 1
here is that it loves good stories good
stories about in the
your cases now a system to system two is
the very human system it’s it’s rational
conscious thinking and it’s active when
we are doing mathematics or when we are
making a difficult maneuver with our
cars it’s much younger than system one
from an evolutionary point of view and
well it doesn’t work that easily yet you
need to switch it on consciously it
works slow slowly it takes a lot of
energy to use system too and it often
feels hard like I’m thinking that’s
failing and now on to public health one
way to apply the knowledge on system 1
and system 2 on public health would be
how should we handle ourselves as public
health professionals but first I will
focus on the question how should we
address the general public well when we
address the public general public as
public health professionals we often
provide good information and then we
actually focus on the public system too
we say things like Anna I quote from a
general website anything that influences
the likelihood of developing diabetes or
of worsening the condition also
increases the chances of dying from the
condition well this is a very system to
sentence can people understand chances
and statistics this has been
investigated and yes they can they can
understand statistic data they are able
to believe statistic data they can be so
surprised about statistic data that they
go out and tell their friends about it
so by then system 2 is definitely
convinced and yet if it’s the statistic
data do not match beliefs people already
has floating about in their system one
then they will not change those beliefs
and these beliefs are intimate they are
about self about your life about the
people you love so nothing will change
because system one is the system that
gets us through the day now how can we
reach system one as well
it’s fairly easy actually you can reach
it by a surprising and emotional story
experience or event about one single
case I have two examples well first my
own standing here is due to the
surprising and emotional case of my
nephew it changed the way I see my
profession and it got me reading and and
learning and teaching even so that’s a
change I think and another example might
be that’s when the US public was asked
you know in research to estimate the
frequency of different causes of death
the public thought that deaths by car
accidents is 300 times more frequent
than deaths by diabetes well if we
imagine the state of the US public then
we know that this can’t be true the
problem here is that well in the
collective mind people stores have so
many stories stored about well single
cases of car accidents stories that are
fearful and emotional and they legs they
lack stories vivid and emotional stories
of death by diabetes I think that we as
public health professionals have to
connect deaths by diabetes that’s
abstract concepts to individual faces
and to individual stories
not to scare the public but because
people have the right to receive useful
information information that changes
beliefs and that promotes action well
and that in short would be information
about individual cases now on to my next
topic what can we as public health
professionals learn for ourselves from
research on decision and error I would
like to propose here that we make a
conscious effort to employ system to
while we are doing our job and I will
focus here on the tension between
coherence and ambivalence system one
with its law for good stories
it’s very formed of coherence of stories
that match fluid easy thinking just goes
on and it does not like ambivalence it
could be there so it could be that it
doesn’t like doubt or uncertainty we as
human beings need system to to doubt and
we need system to to ensure ambivalence
I think that we as public health
professionals have to be experts in
actively tolerating ambivalence we often
work with people with as we call it bad
lifestyles they have bad eating habits
or bad habits in smoking and drinking
and still we have to be able to look
beyond the bad lifestyle we have to be
able to connect with the strengths of
these people and to activate a sense of
human dignity
this may sound it’s the normal and
obvious thing to do but unfortunately in
in real life it can be a struggle to
keep this ambivalence alive bad
lifestyle good people especially if a
public health professional is already
well over burdens or exhausted
I’ve got another example a very
sensitive topic the detection of child
abuse when I myself worked as a per well
child care physician I noticed how
difficult this task is I often liked the
people the parents that were sitting in
front of me and yet sometimes I really
had to have suspected of child abuse and
it was difficult to tolerate this
ambivalence nice people bad things and
perhaps it even made me having to
tolerate the idea that I myself while
being nice would also be able to do bad
things now if we as public health
professionals do suspect a case of child
abuse we never know what the outcome
will be
it’s terribly uncertain this situation
and your your whole system one is
screaming at you there’s ambivalence
here there’s danger we should withdraw
and avoid quick and yet we have to
persist we have to do our job
to conclude I hope have shown that
knowledge on decision making and
cognitive error is useful in prevention
and public health and I proposed here to
pay attention to the system one of our
clients and to the system – of ourselves
I’ve plead to dive into storytelling and
into ambivalence I started out with the
story of my nephew and I’m very happy to
tell you that this story ends well
despite this orange sized hole in his
brains he recovered in an amazing manner
he’s 6 years old now and goes through a
regular school adult brain would not be
that’s flexible but still I would like
to end here with the idea that we too
have to use our brain plasticity we have
to keep on learning
since this this would be my final and
more hidden goal this TED talk to
demonstrate the value of connecting
public health to other fields of
research and knowledge public health
offers such benefits to society and yet
it can also be so difficult to get
results I think that we owe it to
society to collectively harvest whatever
useful knowledge there is out there from
other fields of research in that way we
can become as effective as possible and
as a useful by effect we train our
system to to the max thank you for your
attention
[Music] you
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