Earlier quoted context omitted.
"My car's making a funny noise." "My computer's acting weird."
But you can't take apart or reboot the chicken.
> But you can't take apart ... the chicken
Well, you can, it just won't "work" afterwards!
‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics
21–30 of 75 posts
Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics
#22Earlier quoted context omitted.
The gut feelings a health care professional gets will vary based on the language the patient uses. The gut feelings a doctor has to a patient saying "I have crushing chest pain" will be different to the patient saying "I have burning chest pain".
Your example perhaps doesn’t lend itself to a discussion of “gut feelings”, since it describes different symptoms quite specifically. In the absence of other information, the first sounds like a heart attack, the second, heart-burn (acid reflux). Gut feeling relies on more abstract concepts, particularly in the context of pediatrics where a child may be unable to verbalise their symptoms.
I agree the specific example is somewhat explicit, but the point being made is valid. Whether it's a subtle choice of words, lack of eye contact, or constant fidgeting. They can all have some additional meaning (or none!).
One example that I've heard is common is about reading body language that might indicate discomfort in talking about a subject, which might suggest under/mis-reporting of an issue.
Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics
#23Earlier quoted context omitted.
"My car's making a funny noise." "My computer's acting weird."
But you can't take apart or reboot the chicken.
And this is why I write software for a living. Because "Take the chicken to pieces to find out why it's broken" makes sense to me, so I'd be a rubbish chicken doctor.
Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics
#24This hits close to home for me. My 3 year old daughter was recently diagnosed with a rare form of cancer (with a rather poor prognosis). We brought her to a pediatritian in two states, both thought it was nothing but "growing pains". Her limp got worse, she was in incredible pain for days. She would develop fevers with no other symptoms. She would mysteriously get better, then a month later it would happen again. Eac…
Not pediatrics, but I had hand issues and went to a handful of doctors over the couse of two years who dismissed me after poking or prodding my hands a couple times. AFAICT there's no way to _know_ a doctor has experience and wisdom, but it's crazy that doctors won't even order relevant tests done. It's not a matter of costs - all they need to do is ask first. In the end I went to the Mayo clinic in Minnesota where t…
My GF's gone through the same windmill, over the span of seven (or more) years before finally getting a diagnosis. Multiple ones actually.
Her abdominal pain issues and discomfort were blamed on period pains first, then IBS (because her mother has that too), until finally, after she herself asked for it, she was diagnosed with endometriosis (and an ultrasound revealed a 10cm cyst).
Likewise, she's struggled with being punished for being a naughty child during her upbringing, school problems, and later depression and suicidal tendencies when put on medication for either depression or birth control. It was only once her son was diagnosed with ADHD that she recognised those symptoms and got herself a similar diagnosis. Both are on proper medication for that now and it's a huge improvement for both.
TL;DR there's still a lot of ailments that aren't easy to diagnose.
Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics
#25Much attention (because Taleb) is given to "having skin in the game" - and rightly so. It's an important and actionable heuristic. Also of tremendous import is "gut feeling" which is called out specifically in the article: "Gut feeling has been defined as an intuitive feeling that something was wrong even if the clinician was unsure why." The disorganized, indescribable, cumulative knowledge of a human practitioner w…
I don't deny that Taleb brings some great insights, but specifically to the phenomenon you describe, a more relevant book could be Kahneman "Thinking, fast and slow".
The "gut feeling" is framed as the result of expertise + many hours of practice with short feedback loops. Intuition is very valuable and esteemed, much like a chess Grandmaster can say "Mat in 4" just by glance at a game, where you would need many hours of thinking to arrive to, at best, a similar conclusion.
Thinking slow is where we start when we learn a skill (from learning to count when we are toddler, to learning to code, play piano or chess, or practice medecine). It is a conscious, slow, energy-hungry process that leave us tired. After many hours of practice, and, importantly, short feedback loops to feed our internal pattern-matching algorithm, we start to "Think fast".
Thinking fast is quick, easy, not easily described by words as a lot of it happens below consciousness. It is very efficient but also error-prone, as it is based on heuristics. A lot of cognitive bias come from it.
Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics
#26Earlier quoted context omitted.
If you are focusing on words, you are missing the big picture. 'Guts feelings' are what you get when your brain process a butt load of informations in a fuzzy way. This includes subtle smells, colors, moves, timing, shapes, sounds, chain of events and how they interact with each others. Words can be a tiny part of it, but usually gut feelings are about all those things you can't process as easily with rational thinki…
The gut feelings a health care professional gets will vary based on the language the patient uses. The gut feelings a doctor has to a patient saying "I have crushing chest pain" will be different to the patient saying "I have burning chest pain".
> The gut feelings a doctor has to a patient saying "I have crushing chest pain" will be different to the patient saying "I have burning chest pain".
Those are quite direct description of symptoms.
Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics
#27> Physiological values are complex in paediatrics. They are more than complicated because although there are published ‘normal values’ which will guide the clinician in knowing whether a child is tachycardic or tachypnoeic, these are in fact reference ranges that were initially based on expert opinion. Although meta-analysis shows these reference ranges to be at least somewhat valid, it is probably safest not to thin…
Yes, but I assume that all children who die in e.g. the States will automatically get an autopsy and a cause of death will be determined, no?
(Note: haven't read the article, so I'm not sure if I'm contradicting anything here or just agreeing with it!)
Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics
#28Let us reflect that medical practice is one of the textbook examples for people making bad decisions due to Simpson's paradox. That the sheer number of highly opinionated people who are confident and wrong is staggering (take nutritional information, for example). That the risk of being embroiled in a good game of political or legal football is high.
On top of that, this is a field that historically has had poor exposure to good engineering practice or mathematics. A field where a researcher's have both the intelligence and lack of exposure to plausibly rediscover integration without being clued in by anyone in the know [1].
There is almost certainly more to be gained by working with evidence and solid statistical practice than there is by gut and guessing. It is hard enough just keeping everyone focused on the measurable evidence and weeding out stats mistakes without pretending that doctors should somehow diagnose based on their 6th sense. That isn't a healthy expectation for any party, including the doctor.
Efforts should be made to figure out what variables they are actually using to make decisions, if those variables are actually useful predictors and then how to systematise them. It is tautologically impossible that an experienced clinicians is detecting undetectable variables in their decision making process.
[1] https://academia.stackexchange.com/questions/9602/rediscover...
Re: ‘Why didn’t you think this baby was ill?’ Decision-making in acute paediatrics
#29Earlier quoted context omitted.
The gut feelings a health care professional gets will vary based on the language the patient uses. The gut feelings a doctor has to a patient saying "I have crushing chest pain" will be different to the patient saying "I have burning chest pain".
> The gut feelings a doctor has to a patient saying "I have crushing chest pain" will be different to the patient saying "I have burning chest pain". Those are quite direct description of symptoms.
The gut feelings a doctor has will be affected by words used by the patient or their relatives.