How sure are you?
Think back to the last time someone asked you a difficult question regarding a patient on shift. How sure were you about your decision? Was there a clear-cut right or wrong answer? And after making your decision, how sure were you that the answer you made was the correct one?
REBEL Reflections Episode 5: Thinking in Bets – Making Better Decisions When You Don’t Have All the Facts
Think back to the last time someone asked you a difficult question regarding a patient on shift. How sure were you about your decision? Was there a clear-cut right or wrong answer? And after making your decision, how sure were you that the answer you made was the correct one?
After reevaluating the patient for the 3rd time in 20 minutes and not being able to shake the feeling something catastrophic was about to happen, I decided it was time to intubate. Walking out of the room I relayed my decision to the primary nurse and let them know what meds I was going to use. “Are you sure?” they asked. I nodded silently as I took off my jacket and adjusted it on the back of the chair. In hindsight, I was not 100% certain, but relaying on my years of training, the voice inside my head and the gnawing feeling in my cut, it felt like the right thing to do. This was not a Code 3 respiratory distress, fentanyl overdose with minimal response to Narcan or even an unconscious stroke patient with the blood pressure of a giraffe. The patient came in working hard to breath, had minimal improvement after meds and treatments and was clearly tiring. Chest x-ray didn’t look terrible, but the bottom line is I still did not have all the information and didn’t really know what was going on. If we tried to wait it out, could he pull through on BiPAP alone? How would the hemodynamics respond to RSI? Would they ever be well enough to be extubated? The reality is that this decision had a full spectrum of possible answers and outcomes, some more right (or wrong) then others and I made an informed decision based on the available information; intubation is where I decided to wager my bet.
Annie Duke, a former World Series of Poker champion, details some of the psychology of decision making in the high-risk gambling in her book, Thinking in Bets. In poker, important decisions must be made quickly in the midst of extreme uncertainty and repeated in rapid succession with each new hand. To learn and improve in this environment, these players learn to embrace uncertainty, tease the luck out of their outcomes and avoid common biases when reviewing their prior performance. As doctors working in Emergency Medicine we often have to do the same thing and the wrong decision could potentially be fatal!
In this episode of Rebel Reflections, four Emergency Medicine Physicians, Jacob White, Marco Propersi, Dan Wolf and Will Smith, discuss how thinking in bets while dealing with levels of uncertainty can benefit our performance and learning in the Emergency Department.
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- How does “resulting” or the tendency to equate a decision’s quality with its outcome affect learning in and after residency?
- How does thinking on the spectrum of more or less right impact our utilization of new research or of implementing a consultant’s recommendations?
- How do you avoid decision fatigue during a long shift?
We will discuss these topics and many more on this episode of REBEL Reflections!
After you are done listening, leave a comment with some of your thoughts about flow or share an experience or two. Also, don’t forget to like and subscribe!
Thinking in Bets of Amazon.com
Post Authors
Will Smith, MD
EMRACast Podcast Fellow
The Socials: @WTSmithMD
Email: WTSmithMD@gmail.com
Daniel Wolf, DO
EMS Fellow – Maimonides Medical Center
Email: DWolf@maimonidesmed.org
Jacob White, MD – PGY 3
Vice-Chair, Emergency Medicine
Nuvance Health Emergency Medicine Residency
Vassar Brothers Hospital, Poughkeepsie, New York
Marco Propersi, DO FAAEM
Vice-Chair, Emergency Medicine
Assistant Emergency Medicine Program Director
Vassar Brothers Hospital, Poughkeepsie, New York
Twitter: @marco_propersi
Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)
