Timothy G. Murray, MD, MBA (00:16):
Hi, I'm Dr. Timothy Murray, co-director of the 54th Annual Aspen Retinal Detachment Society meeting, coming to you live from Snowmass Mountain. This meeting has two invited speakers, and it is my pleasure to be joined by our Taylor Smith and Victor Curtin lecturer, Dr. Tarek Hassan. Dr. Hassan's going to lead us into the context of "Seemed Like A Good Idea At The Time: How our thinking as doctors is often flawed". It was such a pleasure to have you here. You gave such a great lecture.

Tarek S. Hassan, MD (00:51):
Well, thank you, Tim. Honored to be here. It's my favorite meeting of the year. I say it loud and proud everywhere I go.

Timothy G. Murray, MD, MBA (00:58):
I'm always excited when we talk out of our comfort zone. And I think you talked about something that some of us think about, but most of us do not. So can you give me some idea of what drove you to the topic and how you explored it?

Tarek S. Hassan, MD (01:12):
Yeah. I thought for this very important lecture, this very important meeting, I wanted to share something that I think about an awful lot that is a little outside of the normal things that I talk about, the science that I talk about. This is more about cognitive science. And I've always been, for the last 20, 25 years, been very thoughtful about how I think and how do other people think and how do the ways that we think affect our relationship with information that we take in. So our field is very, very busy, full of information from so many sources, whether they're journals or meetings, colleagues, publications, et cetera, et cetera, et cetera. And we are somewhat ill-equipped as doctors to handle this information. In fact, the argument could be made that doctors are actually among some of the most poorly reasoning individuals on the planet for good reasons, but we are taught in medical school and through our daily lives to make quick decisions, almost automatic decisions in environments of uncertainty where we are given a lot of information and we have to recognize patterns and we have to act.

(02:21):
It's good for our daily lives and the emergencies we deal with and the surgeries that we have to do. But it's very bad for complex cognitive analysis and things that take slow and thoughtful approaches to the information given. There's a great book by Daniel Kahneman, who was a Nobel Prize winning behavioral psychologist and economist who wrote a book called Thinking Fast and Slow. And in it, he describes two ways of thinking. System one, which occupies about 95% of our brain activity. And it is the fast daily life, intake information, quickly respond and go on with your day. And 5% of our brain is system two thinking, which is slow, cognitive, complex thought that requires a lot of reasoning. As doctors, we are handicapped because we are forced through our training and our daily lives to be system one thinkers, even more than most people who get that opportunity to sit and think.

(03:24):
As a result, we fall victim to what I call mind traps. These are flaws, bugs in the way that we think that can be divided up into cognitive biases and logical fallacies, two types of effects on our brain. Cognitive biases are real unconscious sort of things that we deal with information automatically, subconsciously. They're basically looking at how we perceive information. And then logical fallacies are what we do to interpret the information that we receive. You can have cognitive biases and logical fallacies, which we often have and they amplify each other. So what you do is you have bad inputs that are being processed through a bad engine, and then our outputs are all distorted. So there are so many biases in our field of medicine that affect the way that we think.

Timothy G. Murray, MD, MBA (04:17):
I love too that you really said to critically think you have to question. And literally you're saying question everything.

Tarek S. Hassan, MD (04:24):
Yeah. And which isn't to say that everything is wrong, and it isn't to say that everything is being presented to you for the purpose of swaying you, but there are so many things that go into the information that we receive. For example, I talked about journal articles, peer reviewed literature. We see talks given, we read papers in other peer reviewed manuscripts, and there'll be references to prior published works, but we never pay mind to the fact that some of those references are in very low impact factor journals where the scientific rigor in analyzing the science behind those papers is not equal to a journal that has a very high impact factor, for example. Yet, one of the biases that we're all subject to is that if it's published, it must be valid and they must be equally valid. It's one of those things that we make a snap judgment with our system one thinking, but we don't question it enough to actually go to the next level to assess the quality of the data.

Timothy G. Murray, MD, MBA (05:25):
And you emphasized how important critical thinking was. And I love that because I think at meetings like this and in our day-to-day lives and as we teach fellows, that means everything. We could talk for an hour, I know, but you did beautifully speaking at our meeting and I enjoyed your synopsis. Thank you very much, Dr. Tarek Hassan.

Tarek S. Hassan, MD (05:45):
I very much appreciate it. Thank you, Tim.