Знание и понимание необходимы, но не достаточны для мудрости.
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Свойство различения должно быть обретено, чтобы достичь мудрости. Различение это способность выделять различные уровни знания и применять понимание с осторожностью. Различение приходит преимущественно с опытом, мы учимся ему по по ходу жизни, обретая способность взвешивать, что более или менее важно в данном контексте.
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Существует ряд ошибок мышления, которые ведут к неправильному диагнозу.
- "выбрасывание якоря" - мышление ухватывается за первую доступную информацию и пользуется только ею, не учитывая все остальное.
- доступность. Из памяти вытаскивается наиболее доступная информация: недавние события или те, которые произвели на нас наибольшее впечатление.
- "приписывание". Истолкование симптомов соответствуют социальным представлениям. Если приходит пожилой небритый человек и говорит, что он раньше был моряком, любит пропустить рюмочку рома перед сном, то жалобы на печень будут приписаны алкоголизму, хотя возможен и целый ряд других причин.
Мудрость в диагностике, таким образом, включает не только знание биологии, но и понимание того, как работает ум.
Распознавание того, что в работе ума участвуют предрассудки, называется
метавосприятием.
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While knowledge and understanding are necessary for wisdom, they are not sufficient.
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The attribute of discernment must be acquired to reach wisdom. Discernment is the ability to discriminate, to distinguish different levels of knowledge and to apply understanding in a prudent way. Discernment comes largely from experience, learned as we move through life acquiring the ability to weigh what is more or less meaningful in a particular context.
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Working at the Hebrew University in Jerusalem some three decades ago, Kahneman and Tversky defined a series of thinking errors that helps explain misdiagnosis. The first error is termed “anchoring.” Anchoring occurs when the mind seizes on the first bit of data it encounters and runs with it, rather than considering the full array of potential information. Physicians commonly anchor onto the first symptom or laboratory finding or observation from the physical examination and then quickly draw a conclusion. This conclusion is often correct, but sometimes the doctor has failed to consider that this first bit of information might not provide the key clue to the underlying problem.
A second cognitive error is termed “availability”: we retrieve from memory what is most available, specifically cases recently seen or ones that made a deep impression on us. For example, if we are in the midst of a flu epidemic, then we tend to assume that the patient who comes in with fever, cough, and chills has the flu. The mind is then biased to ignore important findings that contradict this assumption.
A third thinking trap is termed “attribution,” whereby we conform symptoms and clinical findings to fit social or cultural stereotypes in our minds. If an older man comes in unshaven in shabby clothes and tells us that he is retired from the merchant marine and likes to have a glass of rum at night, we will attribute his enlarged liver to alcoholism without stopping to consider that he might have only one glass of rum at night and that there may be a long list of other potential explanations for his liver abnormality beyond alcohol. But the stereotype in our mind tends to bias our thinking and lead us to a premature conclusion.
Wisdom in diagnosis, then, involves not only deep knowledge about human biology and an understanding of the array of diseases that plague humankind but also knowledge and understanding about how the mind works in coming to conclusions. Discerning when these biases are operating in our minds is called metacognition, the ability to think about our thinking. The attribute of humility is embodied in the concept of metacognition; we recognize that our minds are imperfect, that there are limits to the validity of our assumptions, that we are subject to biases, and that therefore we must have the sharp sense to doubt our judgments and question whether we considered everything that should have been considered. Metacognition is essential to clinical wisdom. Why? Because even the minds of the most highly trained doctors are imperfect. These imperfections are amplified when we think under conditions of time pressure and uncertainty, the very conditions of clinical decision-making in today’s medical world. With more patients being seen in ever shorter appointments, physicians are pushed to make rapid judgments, to take shortcuts, and to fall into thinking traps.
Источник 
Тема: Мудрость и ошибки мышления (на примере диагнозов) (Прочитано 1128 раз)
