Adi Kumar Profile picture
May 22, 2022 27 tweets 5 min read Read on X
Elon Musk tweeted about 50 cognitive biases everyone should learn.

It’s a thought-provoking list.

But the infographic (see below) is difficult to digest.
@M_El_Sheikh

#neurosurgery #decisionmaking Image
Decision-making is a key but under-discussed component of neurosurgery.

I’ve re-summarized the 50 cognitive biases Musk recommends to learn.

Each has it’s own neurosurgery example drawn from experience.

Today I’ll share the first 25, tomorrow the second half.
@MDCearns
First, a quick note about cognitive biases.

What are they?

Why is knowing about them crucial?

All humans make systematic errors in thinking—hurting our judgment.

Being aware of cognitive biases will make you less susceptible to them.

Let’s get started.
Fundamental Attribution Error

We judge everyone else on character but blame our shortcomings on the situation.

Example: Your FY2 is late for work, so he’s lazy. If you’re late for work, it’s because of traffic.
Self-Serving Bias

We chalk failures up to the situation while taking all the credit for our successes.

Example: You cured the patient’s leg pain with your microsurgical skill. Meanwhile, their wound broke down because the ward isn’t clean.
Ingroup Favoritism

We privilege those in our ingroup over those in an outgroup.

Example: Simon works in neurosurgery, so you value his opinion more than Anna, who works over in orthopaedics.
Bandwagon Effect

Concepts, trends, and beliefs catch on as more people validate them.

Example: Everyone wants to use the new Kinevo microscope that’s on demo, even though it’s just the same as the Zeiss.
Groupthink

We make irrational decisions just to avoid conflict.

Example: You put the infected case at the start of the list because the patient has complained in the past.
Halo Effect

Focusing on one trait (positive or negative) as being indicative of the whole.

Example: Michael must be a great surgeon because he went to Oxford.
Moral Luck

Equating moral superiority with a positive outcome and moral inferiority with a negative outcome.

Example: He’s a prisoner so it’s not surprising he got a post-op complication.
False Consensus

We assume others agree with us by default.

Example: “Obviously this patient wouldn't want an operation because of their age.”
Curse of Knowledge

We believe that everyone knows the same things we do.

Example: You get pissed off at another “CES” referral that has no back or leg pain.
Spotlight Effect

We think people are paying far more attention to us than they are.

Example: You miss some calls on the on call phone because you’re busy and now imagine the CMO is on the phone to your consultant.
Availability Heuristic

We make snap judgments based on the most recent information.

Example: Drop in GCS = needs CT scan.
Defensive Attribution

The tendency to blame others for your mistakes out of self-protection.

Example: “I opened the wrong side of the head, because no one stopped me at the time out to say I was pointing at the wrong side.”
Naïve Cynicism

The assumption that others act only out of self-interest.

Example: "The only reason the medics are referring this patient, are to cover their own backs.”
Forer Effect (aka Barnum Effect)

We see ourselves reflected in things that could apply to many.

Example: “Neurosurgeons are very hard working.”
Dunning-Kruger Effect

The overestimation of ability when one has little experience.

Example: You are now on the on call registrar and believe lumbar microdiscectomies are easy cases.
Anchoring

We make decisions based on first impressions.

Example: “It’s a consultant referring a patient. This is will be straight-forward” (never is).
Automation Bias

We put too much trust in automated systems to fix our mistakes.

Example: BrainLab/STEALTH said do the burr hole here for a shunt (on sagittal sinus)
Google Effect (aka Digital Amnesia)

We don’t store information in our brains that’s conveniently found online.

Example: “What’s the dose of mannitol…?”
Reactance

We go against orders, especially when we see them as an assault on our freedoms.

Example: “I’m not going to touch the patient so why do I need to wear a pinny, gloves and visor?!”
Confirmation Bias

We seek out (and retain) information that confirms what we already believe.

Example: Drains for CSDH are lethal. Points out single complication in 200 as proof.
Third-Person Effect

We see ourselves as more immune to media than others.

Example: “You shouldn’t worry about being sued so much.” Then documents 3 pages in the notes for every CES patient.
Belief Bias

We tend to accept the outcome of an argument only if it matches what we believe.

Example: TBI causes oedema. Steroid reduce oedema. Therefore steroids are treatment for TBI.
Backfire Effect

You interpret evidence that disproves your belief as a confirmation of it.

Example: A patient you didn’t want to operate on gets better after a second opinion and surgery from a colleague. “See. They would have gotten better either anyway.”
Boom. 25 cognitive biases that everyone should know as it applies to neurosurgery.

If you learned something, please RT the first tweet.

Understanding cognitive biases makes better neurosurgeons.

Let's spread this important message.

If you enjoyed this, follow me for more.

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More from @adi_kumar1

May 25
I have delivered over 10,000 hours of emergency neurosurgery care.

Here's advice to myself back in 2014. Image
1 - Don't Multitask

"Multi-tasking" is a word created by IBM in 1965. It was used to describe a computer, not a human.

Focus 100% on the task at hand then move on to the next.

Most of my mistakes have come when multi-tasking.
2 - Call for Help

If you think you need help, you need help. The small voice in your head means you should pick up the phone.

No one will say, "Why did you call me?!"

They will say, "Why didn't you call me?!"
Read 14 tweets
Feb 23
I have delivered over 10,000 hours of emergency neurosurgery care.

Advice to myself back in 2014 🧵 Image
1/ Call for Help

If you think you need help, you need help.

The small voice in your head means you should pick up the phone.

No one will say, "Why did you call me?!"

They will say, "Why didn't you call me?!"
2/ Urgent does not Equal Important

What is urgent for someone else, is not always important for you.

Urgent = time critical, for you or others.

Important = in keeping with your job of providing emergency care.

Focus on the urgent and important.

Use the matrix below. Image
Read 16 tweets
Feb 20
The over-confident surgeon causes harm by doing too much.

The under-confident surgeon causes harm by doing too little.

5 steps to building surgical confidence 🧵 Image
The old model of confidence said, "fake it 'til you make it".

To act confident and have absolute belief in your skills.

But the person who proclaims their confidence is anything but confident.
My weekly newsletter contains reflections on life as a neurosurgeon.

It'll teach you how to own your work and your life.

If you're interested, you can sign up here:

adi-kumar.ghost.io
Read 12 tweets
Feb 9
Why being a surgeon is a Loser's Game 🧵 Image
In the 1999 book, Extraordinary Tennis for the Ordinary Tennis Player, Simon Ramo explained the difference between amateur and professional tennis players.

It goes like this...
Amateur tennis is a Loser's Game. 80% of points are lost on unforced errors.

You win by avoiding errors and waiting for your opponent to make errors.

Professional tennis is a Winner's Game.

80% of points are won on incredible shots. You win by hitting incredible shots.
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Feb 6
The operating room is a hostile environment for surgeons.

38% of surgeons are in pain.

87% if using an endoscope.

A primer on surgical ergonomics to save you suffering 🧵 Image
Ergonomics is dedicated to understanding the interactions between humans and systems.

It focuses on making sure the environment fits the worker.

Physical, cognitive and organisational ergonomics create safe and efficient work environments.
There are 4 parts to physical ergonomics in the OR - personal equipment, theatre setup, posture and stretching.

Let's take a look at each.
Read 14 tweets
Dec 18, 2023
As a neurosurgeon I've taught about the Dunning-Kruger effect.

But it isn't real.

If you think it is, this will be an eye-opener.

If you haven't heard about it before, you will still learn how false ideas can be useful and true ideas can be harmful. 🧵 Image
Towards the end of surgical training, you are particularly dangerous.

If you've passed your final exams then you are doubly dangerous.

Your governing body has agreed that you have the knowledge to operate independently.
But that knowledge does not mean you have the experience of how best to use it.

One of the most difficult skills to learn is when not to operate, even if you think you can.
Read 21 tweets

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