One story is especially obnoxious, as Gawande recounts how a “gut feeling” about a case of infection causes him to persuade a patient to undergo an extensive biopsy which reveals she has life-threatening necrotizing fasciitis, caused by the popularly-known “flesh-eating bacteria”. He explicitly acknowledges that he had no logical reason for regarding the case as unusual, that all appearances indicated a routine cellulitis which was approximately three thousand times more likely than necrotizing fasciitis was—and that he had recently taken care of a patient who had died agonizingly from a massive infection of the flesh-eating bacteria. And yet the story is presented as an example of how to deal with uncertainty.
I agree Gawande isn’t especially virtuous here; it would be nice if he’d sought statistics on how often his hunches were correct. But don’t condemn him too quickly either. There are some theories, even some ones with experimental support, that suggest intuitions are often the sum of reasoning processes that don’t reach the conscious level. The case you describe: where everything seems okay but you have a nagging feeling in the back of your head that it isn’t—is especially a red flag in that regard. I recommend Jonah Lehrer’s How We Decide for more on this.
Yes, but they’re also the sum of prejudices, irrational convictions, short-circuited reasoning processes, and other biases.
Gawande discusses the decision to try to remove only the affected tissue rather than go for amputation—a decision which seems to work out. Then he asks how he and the other doctors knew they could spare the leg.
That’s a fundamental failure, changing a guess to knowledge in highsight.
I agree Gawande isn’t especially virtuous here; it would be nice if he’d sought statistics on how often his hunches were correct. But don’t condemn him too quickly either. There are some theories, even some ones with experimental support, that suggest intuitions are often the sum of reasoning processes that don’t reach the conscious level. The case you describe: where everything seems okay but you have a nagging feeling in the back of your head that it isn’t—is especially a red flag in that regard. I recommend Jonah Lehrer’s How We Decide for more on this.
Yes, but they’re also the sum of prejudices, irrational convictions, short-circuited reasoning processes, and other biases.
Gawande discusses the decision to try to remove only the affected tissue rather than go for amputation—a decision which seems to work out. Then he asks how he and the other doctors knew they could spare the leg.
That’s a fundamental failure, changing a guess to knowledge in highsight.