Pat Croskerry on Successful Decision-Making

What elements contribute to successful decision-making?

When discussing the downside of heuristics the other week, I referred to Dr. Pat Croskerry and his 2005 paper on The Theory and Practice of Clinical Decision-Making.  Although Croskerry's research focuses on decision-making by physicians, his conclusions clearly have implications for the rest of us.  From his paper's final passage, titled "Towards a universal theory of decision-making":

The successful decision-maker will be one who has an ergonomically optimized workplace, is well rested and well slept, is not driven by throughput pressures, is aware of the various cognitive and affective biases, and is able to safely blend cognitive intuitive and analytical styles according to the particular task at hand. This last is especially important. It invokes the concept of situational awareness - knowing what has gone before, what is happening now, anticipating what is coming, and then having one’s cognitive engine in the right gear. Occasionally, it may have to be metacognitively kicked up a notch to match the situation.

So how might we improve the quality of our own decisions?  Some of Croskerry's recommendations are obvious (although my experience is that they're ignored routinely):  Make your workspace physically comfortable.  Get enough sleep.  Resist "throughput pressures" and take the time you need to think clearly.

But he also touches on two topics that require more effort to fully understand and integrate into our daily routines:

1. Be aware of cognitive biases.

Croskerry believes that some of our heuristics are by-products of evolution:

[T]here are persuasive arguments that we may be hard-wired to respond to certain features of our environment as well as to processing information in predictable ways... If there is any feature of cognitive activity that might influence whether or not our genes get into the next generation, decision-making would appear to be a good bet - presumably good decision-makers have a higher rate of survival.

But this suggests that we need to take great care to understand and compensate for the biases that stem from our cognitive inheritance:

If we come to accept that certain [cognitive dispositions to respond] are, indeed, hard-wired, there are important implications... If heuristic strategies are the stuff upon which cognition evolved...it places an even stronger imperative on the need for research into de-biasing strategies - finding ways of undoing our innate tendencies that evolved in simpler times and which now may be counter productive in modern medicine.

How to put this into practice?  One way to start is to understand the cognitive biases that may be affecting our decision-making.  (I suspect I'm predisposed toward confirmation bias.)  Awareness by itself is insufficient to create change, but change is impossible without it.

2. Match the appropriate cognitive style to the task at hand.

Although this point raises a number of questions that are well worth further exploration--What are the different cognitive styles at my disposal?  What's my default style?  To what extent can I change styles, and how much effort will be required to do so?--I think it's possible to boil it down to a simple imperative: Learn when to trust your instincts...and when to distrust them.

As Croskerry notes, situational awareness is key, and even in a state of heightened perception we may have to "metacognitively [kick it] up a notch" to match our style to the situation.  Essentially this means we sometimes need to "think about how we're thinking."  Should we go with our intuition?  Or should we discount our intuition and be more analytical?  (And clearly, familiarity with the cognitive biases noted above will help us select the right cognitive style.)

Comments

[peter vajda]

So, Ed, I'm curious.

Since much of what you write about here is about the "mind" in its various flavors - cognition, styles, etc., what if one did not use the "mind" (i.e., that database of information in the brain) and instead turned "inside" into the wisdom of the body (spoken about for thousands of years in Eastern traditions) and more recently pointed to in various forms of "presence" work in Western society.

I'm curious if your work in your courses,etc., does or might consider, for example the "focus" work of Eugene D. Gendlin, Ann Cornell, and the like (and I have no connection to these folks...just like and use their work in my coaching practice and life)moving into the body and allowing the discernment from an inner approach to inform one's decisions.

This body-generated wisdom, albeit it comes through the "brain", is not generated by the brain's storehouse of information/styles,. etc., is not "contaminated" by learning, information, preconceptions, misperceptions, hard-wired beliefs, self-images, etc., all which can contaminate one's decision-making process, usually unconsciously.The energy of the process and experienece of discernment from within and is pure(r) and comes from a place of authenticity and integrity and "truth". So, maybe decision-making can also be about "not thinking about thinking" and a no-mind, or "beginner's mind" experience. Thinking about thinking is also influenced by thinking and is very difficult to "objectify" as we still may unconsciouslyt bring our biases, beliefs, emotions, etc. to the process.

Just a thought and thanks for the provocative posts.

[Ed Batista]

Thanks, Peter--I appreciate the interest and the alternative perspective. I don't know much about it, but I'm certainly open to the concept of "body-generated wisdom." And I agree with you that "thinking about thinking is also influenced by thinking" (although just typing that phrase makes my head hurt a little), which puts some limits on our ability to think our way out of these dilemmas.

I also believe that if we want to make more effective use of our intuition, we need to be more aware of our bodies and the physical sensations that accompany emotions and instinctive feelings.

Ed