Preparing for the Black Swan: 21st century medical decision making

Damian Roland dr98@le.ac.uk

Abstract

The hypothetic-deductive approach to diagnosis by health care professionals has served medicine well for centuries. However, as patients become more empowered to be shared decision makers in their investigations and treatments, it is important that medical modals remain fit for purpose. Specifically in urgent and emergency care, but also relevant to many specialties, there are diagnoses which have huge consequences for patients if missed and result in potential disabling second victim phenomena in staff. Sepsis is an example of this where a "pragmatic" approach may not always be in a patient’s best interest.

This talk will explore Black Swan events, a process first encapsulated by Nassem Taleb in his economics work, and apply their use in Medicine. The name is taken from the impact that the discovery of Black Swans in Western Australia had on the prior notion that all swans were white. A Black Swan event, as described by Taleb, would not be considered a possible outcome based on past history, but has a huge impact when it occurs and only on retrospect is it realised to be a potentially predictable event. Taleb developed his theory through his experience of working in the banking industry and his observation that many so-called experts were blind to the potential of instability in financial markets (e.g. banks being too big to fail). He argues you cannot predict Black Swans, as if you could they would not be Black Swans, but you can mitigate their impact if you are prepared they may occur.

The Black Swan model will be used to examine the way doctors are trained to make decisions and suggest how this may need to change to improve patient outcomes and experience.
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