Why our opinions get us in trouble

“The history of human opinion is scarcely anything more than the history of human errors,” Voltaire said a long time ago.

Health professionals are trained to give opinions. It’s what we do every day in caring for our patients and leading our teams. Sometimes, however, it’s better not to give an opinion – or at least sit on it for a while.

Admittedly this is not always easy to combine with busy clinics, fast-paced lifestyles, opinion-based social media and rapid news cycles.

Nobel Prize winner Daniel Kahneman described two ways of thinking in his well-known book ‘Thinking, Fast and Slow’.

The first method, which he called system one, is fast, intuitive, runs automatically and cannot be switched off. It generates first impressions and intuitions based on experience. It is however subject to errors and biases and is poor at performing statistical estimates.

The second way of thinking, referred to as system two, takes more conscious effort and time. It is normally in low-effort mode but when system one runs into difficulty, system two will be engaged.

The two systems can work effectively together, as long as we are aware that our first guess, based on system one thinking, may not always be right and that we need to verify it by applying more analytical system two thinking.

The challenge, as I see it is, to have an opinion and an open mind at the same time.

This is an edited version of an article originally published on NewsGP.

New skills, fewer scripts and less screen time: 3 resolutions for the new year

Richard Branson said we should put our resolutions in black and white, because that helps us stick to it. Just in case he is right, I wrote down 3 professional & personal resolutions for the new year.

1. Learn a new skill

Rightly or wrongly, one of my fears is deskilling – at a personal level, but also at a macro level as a profession. As Dr Margaret McCartney wrote in the BMJ, the enterprise to streamline medicine by outsourcing certain tasks to protocol-driven non-doctors, runs the risk of deskilling generalist doctors.

There are probably other reasons for losing our skills, such as policy changes and the costs of consumables and maintaining skills. But we can’t always blame others for everything, so I have decided to learn at least one new skill every year.

2. Change prescribing habits

I have made a conscious effort over the years to reduce unnecessary antibiotic prescriptions. I am doing the same with opioid analgesics for chronic non-cancer pain, in line with new RACGP guidelines.

In the case of antibiotic prescribing I had to overcome a few hurdles, such as the fear of not meeting my patients’ expectations or leaving a serious infection untreated.

Talking to colleagues was helpful and I found that – after a careful history, examination and explanation – most patients accept a ‘watch & wait’ approach, with appropriate safety netting.

I feel better for practising less defensive, ‘play it safe’ medicine, which in the end may not be as safe as we’d like to think.

There are parallels when it comes to prescribing opiates. After the GP17 Conference in Sydney I took the RACGP’s 12-point challenge to GPs (see image) and found that I am now spending more time talking with patients about the pros and cons of opioids.

Yes, it is easy to slip up, especially under time pressure and just before lunch or closing time. However, by perseverance the snail reached the ark. I find every small successful dose reduction or non-pharmacological intervention satisfactory. I hope this will be a drive to continue the conversations with patients.

12 point challenge
Image: The 12 Point Challenge to GPs. Source: RACGP

3. Spend less time behind screens

Excessive screen time for children may be linked to several adverse health outcomes, so at home we use an app to limit the recreational time our children spend on their devices – making sure they have opportunities to learn, create and connect in the digital space. This sounds great but in reality it is a never-ending balancing act. It also made me realise that I may not be the best role model here.

It turns out most adults spend more time on their digital devices than they think, which was certainly true in my case. Some of the time behind screens, such as in the consulting room, is difficult to cut back but not all screen time is essential.

I took a social media ‘holiday’ during the month of December and it felt good. So this year I will unplug more often from the social media fire hose. I may even read a book.

This article was originally published in newsGP.