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Important point about post-hoc decision analysis 
Similarly, just because the outcome was good doesn’t mean decisions were right / a mistake wasn’t made.
I find helpful the analogies of decision-making (and post-hoc reflection) between medicine and poker.
Thread 1/10 https://twitter.com/mkittlesonmd/status/1351870088362696707
Similarly, just because the outcome was good doesn’t mean decisions were right / a mistake wasn’t made.
I find helpful the analogies of decision-making (and post-hoc reflection) between medicine and poker.
Thread 1/10 https://twitter.com/mkittlesonmd/status/1351870088362696707
In a poker hand, you often have uncertainty in the current situation - specifically your opponent’s hand.
This is analogous to diagnostic uncertainty in medicine.
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This is analogous to diagnostic uncertainty in medicine.
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But even if you know almost for sure what’s going on - with the diagnosis or the opponent’s hand - there is still an element of chance affecting the outcome.
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In poker, it’s the next card that’s dealt randomly.
In medicine, it’s the body’s incredibly complex, sometimes fragile, sometimes resilient nature. Our best interventions aren’t 100% effective. We may get worse and die despite them. Or—withstand the harm they caused.
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In medicine, it’s the body’s incredibly complex, sometimes fragile, sometimes resilient nature. Our best interventions aren’t 100% effective. We may get worse and die despite them. Or—withstand the harm they caused.
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There’s even a term in poker for the @MKIttlesonMD described: a “bad beat.”
You made the right diagnosis of your vs your opponents hands/chances. The odds were in your favor. You just got unlucky.
And this shouldn’t alter your future behavior.
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You made the right diagnosis of your vs your opponents hands/chances. The odds were in your favor. You just got unlucky.
And this shouldn’t alter your future behavior.
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Or the opposite happens. You make a bad call, where you’re statistically likely to lose, but get a lucky card.
You made a mistake, but won.
And it’s important to recognize this too, and learn a lesson about changing future behavior despite the fact that you won.
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You made a mistake, but won.
And it’s important to recognize this too, and learn a lesson about changing future behavior despite the fact that you won.
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The difficulty in medicine is that our feedback for diagnostic / therapeutic calibration is very cloudy and confounded, or absent altogether.
We often just don’t know whether we were right, or wrong but lucky.
Wrong, or right but unlucky.
@PrathitKulkarni @Gurpreet2015
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We often just don’t know whether we were right, or wrong but lucky.
Wrong, or right but unlucky.
@PrathitKulkarni @Gurpreet2015
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But it’s still worth analyzing. By the time the outcome had happened, there is often more new collateral data to see, or old data to re-analyze.
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Was the diagnosis(-es) correct?
Were decisions about treatments justified based on available literature and unique characteristics of the pt that may have altered individual risk/benefit analysis?
Conclusion might be yes, no, or maybe. But process is always instructive.
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Were decisions about treatments justified based on available literature and unique characteristics of the pt that may have altered individual risk/benefit analysis?
Conclusion might be yes, no, or maybe. But process is always instructive.
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Finally: even if you conclude that you made a mistake—which you will tend to think despite the uncertainties above—forgive yourself.
This stuff is really hard. We all make mistakes. All we can do is learn the lesson and recommit to doing our best going forward.
@DxRxEdu
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This stuff is really hard. We all make mistakes. All we can do is learn the lesson and recommit to doing our best going forward.
@DxRxEdu
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