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Sunday, November 24, 2013

Putting things in perspective

One of the challenges we face a physicians is to both understand risk ourselves, and communicate risk to our patients. We are hamstrung by basic human foibles, most notable being our inability to grasp the difference between how different a risk of one in one thousand might be from a risk of one in one billion. Our ancestors developed in a world where understanding such differences in size were simply not relevant. Unless particularity trained, our brains do not ascribed significant differences to these differences.

The Teaching Company course on Big History taught by Dr. David Christian is a great resource for beginning to grasp how significant these differences and scales are. The scope of this course is to cover the history of the universe, startling with the big bang and moving to contemporary history; 13 billion years in 48 lectures. The entire first lecture is a discussion of nothing more than understanding the size of the universe and the time scale to be addressed, looking at orders of magnitude (powers of ten). He gives a quick Ted Talk summarizing this in 18 minutes.

I recently saw a piece posted on the Big Picture blog by Barry Ritholz which provided a good visual representation of this (Big Picture link). I also tracked this back to another nice blog  ( I really like authors who dwell upon these concepts since I see this as a major shortcoming of human cognition and decision making. Our fascination with critiquing and judging events in a moment to moment fashion, is destructive. This when combined with our other tendencies to create stories out of random chatter prompts us to act hastily and value action over reflection.

While we physicians (and other health care professionals) do not work on universe life-time scales of time, we still are called upon to understand phenomena occurring within huge a spectrum of probability, needing us to understand quantitative concepts which we are ill suited to grasp. This may all seem to be an pointless intellectual distraction except for the fact that it is not. As our scope of work in health care has moved to assessors of risk and providing advice to patients regarding events that might affect them in the future, it is absolutely essential that we are able to understand orders of magnitude and furthermore, be able to communicate this understanding to patients.

My training failed to prepare for this task. Given what I read of the medical literature, the preparation of my colleagues was equivalently inadequate. Our rights of passage required us to do and survive all sorts of things in our training. It did not require us to understand risk and probability in any sort of real quantitative fashion. Whatever appreciation I have developed regarding perspective, size, risk, and orders of magnitude has for the most part developed as a consequence of reading and listening out side of the medical field.

I hope this is changing.

1 comment:

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