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    Suggested summer reading: The Undoing Project

    A book that examines how humans think explains both our strengths and weaknesses as practitioners.

    There are books you enjoy reading, and then there are books you can’t wait to tell your friends about. But the best books are the ones you actually buy for your friends to make sure they read them. Michael Lewis’ The Undoing Project falls in that latter category.1

    I admit to being an avid Lewis fan, having read almost all his books. He has a unique talent for explaining complex economic, financial, and statistical concepts in a readily understandable fashion, in part by weaving explanations into compelling tales about intriguing people. The Undoing Project does just that, telling the story of the extraordinarily synergistic collaboration and close friendship between 2 brilliant Israeli psychologists, Daniel Kahneman and Amos Tversky, who quite literally changed the way we think about thinking. The book is also a fascinating story about the sources of human creativity, the power of teamwork, and the ability to discern profound scientific concepts from seemingly mundane and decidedly low-tech observations. The psychologists’ story is made all the more compelling by its dramatic backdrop, set against the tumultuous birth of Israel, and its rich intellectual development accelerated by the ever-present and existential threat of war. But all of that is not why you should read the book.

    How do humans think?

    The Undoing Project should be read (especially by physicians) because it describes, in a lucid and compelling manner, how we think and why we so often make mistakes. It details our highly evolved, very efficient, and incredibly rapid ability to intuitively discern relevant features out of complex patterns using associated reasoning. This allows us to reach judgements about our environment (eg, safe vs dangerous) and make choices among possible actions by weighing risk versus reward. Kahneman described this process as System 1 thinking, which employs cognitive short cuts or heuristics.2 While this process is usually highly efficient and effective—explaining the dominance of Homo sapiens, it occasionally leads to major errors in judgment (eg, becoming dinner for a lion, tiger, or bear or a Bernie Madoff). For physicians, it explains our ability to walk in a patient’s room and make an instant and lifesaving diagnosis or make the wrong diagnosis, order the wrong medication, or operate on the wrong side of a patient. Fortunately, we are also endowed, to variable degrees of proficiency, with the ability to think slowly, carefully assembling and analyzing data, testing assumptions, coming to sound conclusions, and making few errors. Kahneman refers to this type of cognition as System 2 thinking.2 But it’s the errors inherent in heuristics that are the focus of Michael Lewis’s book as well as of much of Tversky’s and Kahneman’s early careers.3

    Lewis starts of where his book Moneyball ended, showing the power of predictive analytics in putting together winning MLB teams for less money. But he points out that there are limits to such an approach, and that these limits reflect fundamental errors in the way even seasoned scouts view potential athletic talent and the probability of future success. He notes that even highly successful scouts often err by focusing on an athlete’s readily identifiable but often irrelevant characteristics because they fit a preconceived bias (eg, scouts missed Jeremy Lin’s potential because Chinese-American shooting guards from Harvard didn’t fit their stereotype). This is why so much conventional wisdom is just plain wrong. The rest of the book describes how Kahneman and Tversky discovered the sources of such errors by deconstructing human cognition and decision making. It also details some of the effects of their discoveries on various disciplines including medicine and economics.

    A friendship that changed our minds

    Kahneman survived a harrowing childhood in Nazi-occupied France, emigrating to Israel after the war. Tall, introspective, and deeply analytical, he graduated from Hebrew University with a degree in psychology and was assigned by the Israeli Defense Forces to identify personality types likely to succeed in various military fields. Kahneman quickly discerned that military stereotypes were of little value because they were subject to a variety of biases. In contrast, the Israeli-born Tversky, was short, voluble, extroverted, energetic, and supremely self-confident; he was a paratrooper and legitimate war hero. He also studied psychology and became intensely interested in the science of decision making. Both Kahneman and Tversky undertook graduate studies at the University of Michigan but their collaboration blossomed when they returned to Israel and joined the faculty of Hebrew University in 1969.

    Recommended: The cyberthreat to American healthcare

    The 2 would spend long stretches talking, hypothesizing, shredding each other’s arguments, and proposing clever tests for pet theories—often undertaken on unsuspecting undergraduates. They initially focused on errors made by trained statisticians due to an acceptance of conclusions based on small Ns—a common mistake even today in medicine. Next they discerned that common errors in judging the probability of events usually resulted from misapplication of basic heuristics. These heuristics include representativeness, availability, and anchoring.

    NEXT: Ways of making errors

    Charles J Lockwood, MD, MHCM
    Dr Lockwood, Editor-in-Chief, is Dean of the Morsani College of Medicine and Senior Vice President of USF Health, University of South ...

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