As a departure for the “usual and customary” blog post, I’m sticking my neck out to call reader’s attention to a book suggested to me by Philippe Collin. You may or may not be aware of it.
Thinking, Fast and Slow, written by Nobel Laureate Daniel Kahneman, can help shoulder surgeons gain important insight into how they make decisions. It explores the interaction between fast, intuitive, instinctive, emotional thinking (“System 1”) and slow, deliberate, logical thinking (“System 2”).
System 2 strives to avoid these errors, but requires substantial effort, deliberation, concentration, logic and data; it should be brought into play for complex impactful decisions and when the lazy System 1 is at risk for failure. It asks questions like “For the different treatment options, what are the published base rates for good and adverse outcomes; improvement in comfort and function; and time to recovery for similar patients with similar diagnoses?” and “H
ow do we reconcile the data indicating that (a) less than 5% of patients with rotator cuff tears have surgery with (b) rotator cuff surgery is the commonest of shoulder surgeries?” It also asks questions like “what accounts for the variability among surgeons (e.g.surgeon training, practice environment, economics, age)”? as well as “what factors may bias decisions among treatment options (e.g. a surgeon with a financial interest in an outpatient surgical center may be biased toward patients and treatments that can be accommodated there)? System 2 should be informed by a surgeon’s personal documented outcomes and complications for similar patients with similar diagnoses that she or he has treated. System 2 should consider contradictory evidence against a considered surgery before proceeding: what are the “cons”. System 2 invites a colleague’s opinion when the decision-making is difficult. System 2 requires concentration, which may be compromised by distracting conversation or music in the operating room.
Finally, the book points out that people, including surgeons and patients, are only human. The decisions individuals make are influenced by “priming” (what happened to them just before making the decision; are they happy, rested, hungry, just having a bad day?) and by “framing”, i.e. how is information presented: if you have $50 would you rather keep $20 or lose $30? (most folks would choose to “keep $20” even though the two choices are equivalent!). Similarly, is a procedure with a 7% revision rate better or worse than a procedure with a 93% revision free record?
With apologies for the amateur nature of this “book report” (my first since I graduated from the University of Texas in 1964), I hope I’ve stimulated your interest in Kahneman and his thoughtful consideration of how we make decisions.
Red-shafted flicker
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Here are some videos that are of shoulder interest
Shoulder arthritis – what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link)
Shoulder rehabilitation exercises (see this link).
