Ninety-Nine Lessons in Critical Thinking

Ninety-Nine Lessons in Critical Thinking was designed to enhance the reader’s awareness of how they think and how decisions involving patients and scientific matters can be influenced by word choice, preconceived ideas, framing, biases, and inattentiveness. Entertaining and informative stories from the author’s 45 year clinical and scientific experience and from the history of medicine and science are presented to illustrate ways in which critical thinking skills can be developed and awareness of thought processes enhanced.

The evolution of human learning and awareness is used to illustrate the fundamental nature of the concepts, and emphasis is placed on ways to enhance awareness of how our attention and words influence thought. Medical professionals (including medical students, residents, postgraduate fellows, graduate students, dentists, and nurse practitioners) are faced with an enormous amount of information coming from scientific literature, computerized patient records and artificial intelligence. Methods for dealing with this avalanche of data and ways to retain focus on key patient and scientific matters are explored, and practical suggestions to improve doctor-patient interactions are included, with a focus on approaching care regarding the patient’s life context and personhood.

The ninety-nine lessons demonstrate how to enhance understanding of the humanity of both the patient and the doctor and how awareness of thought is essential for innovative and compassionate care and research.

• Uses real life examples of patient and scientific issues taken from the author’s experience as a clinician and cognitive scientist
• Contains concise lessons which draw on examples from science, history and human stories from the author’s clinical experience
• Presents lessons from a neuroscience viewpoint, considering how the brain works and the impact of human brain evolution

CONTENTS

SECTION I DOCTOR- PATIENT INTERACTIONS
1. The World Is Too Complex To Perceive Directly
2. The Key Factor Which Determines What We Perceive Is Our Attention and How It Is Focused
3. Which Is Older, Stories or Books?
4. Be Fierce, Nurture an Intense and Ferocious Aggressiveness in the Pursuit of Your Learning and the Benefit of Your Patients
5. “Listen to Your Patient, He Is Telling You the Diagnosis”
6. Be a Good Observer
7. Consider the Patient’s Experience
8. Learn from Your Patients
9. Intellectualization Limits Your Compassion
10. Key Elements of the Patient Visit: The Interview and Deep Listening
11. Words Influence Thought
12. The Physical Exam
13. Touch Is Important
14. Be Prepared for the Unexpected
SECTION II DIAGNOSIS AND EVALUATION
15. The Fundamental Three- Step Approach to Diagnosis
16. A Mnemonic for Etiologies, VITAMINS ABCD
17. Investigations
18. Don’t Be Afraid To Say You Don’t Know
19. Information Toxicity
20. Treat the Patient, Not the Test
21. It’s Good To Be Knowledgeable, but It Is Necessary to Also Be Attentive to the Patient
22. Consider Toxic Exposures
23. Family History Is an Important Part of the Interview
24. Rare Presentations of Common Events Are More Common Than Common Presentations of Rare Events
25. Symptoms and Signs Have Important Significance: The Absence of Symptoms and Signs Is Not Always as Important as Their Presence
26. Salutogenesis: The Production and Maintenance of Health
SECTION III MANAGEMENT
27. Get to Know the Patient and Show Interest (the Patient Is a Person)
28. Learn from Clinical Experience (but Not Too Much)
29. Use the Placebo Response to Your Patient’s Benefit
30. Tell the Truth Whenever Possible
31. Cognitive Function Is Relevant for All Areas of Medicine
32. You Are Primarily Responsible for Caring for the Patient, Not the Family
33. Denial of Illness and Disability Can Be Shared by the Patient, the Family, and the Doctor
34. Consider the Context of Care
35. Challenges to the Ability to Provide Humane Healthcare
36. Do Not Confuse Etiology with Pathophysiology
37. Communicate with the Patient
38. Be Attentive to Medications and Medication Errors
SECTION IV CRITICAL THINKING
39. Think Deeply (Think Beyond the Obvious)
40. How Often Do Rare Events Occur?
41. Do Not Depend on Logic Alone
42. Although Intuition Cannot Replace Evidence, It Can Be Valuable
43. Should You Think Out of the Box?
44. All Models Are Wrong
45. Biomarkers Are Not the Disease Itself
46. Absence of Evidence Is Not Evidence of Absence
47. Being Wrong (at Times) Is OK
48. Much of What We Know Is Wrong (So Don’t Believe Everything You Read)
49. Smart People Make Mistakes
50. Fishing Expeditions May Be Productive
51. Manifestations of Bias
52. Experimenter Bias
53. Bias of the Lost Actors
54. Being Smart Is Not Enough
55. Don’t Be Afraid of Your Imagination
56. Do Not Assume That Your Ideas Are Not Novel and Important Just Because They Appear To Be Obvious
57. Consider the Evolutionary Aspects of Disease
SECTION V PERSONAL AND CAREER DEVELOPMENT
58. Live in “Day-Tight Compartments”
59. Learn How To Learn and Enhance Your Learning Capacity
60. Find Out Where You Find Meaning
61. Search for Your Passion and Follow It (Gnaw Your Own Bone)
62. Learn to Critically Read the Literature
63. We Are All Neurologists
64. Neurology and Cardiology (Etc.) Don’t Exist
65. Do Not Respect Boundaries, Be a Trespasser
66. Be Grateful
67. Look Beyond the Easiest Options and Pursue the Best Resources Possible
68. Focus, but Not Too Much
69. Be Persistent and Tenacious
70. Do Not Be Intimidated by Accomplished Persons in Medicine and Science
71. Accept the Help of Others
72. Pay Attention to Your Own Health and Learn How To Deal with Stress
73. Learn from the History of Medicine and Science
74. Recognize Your Intellectual Ancestors
75. You Are an Educator- That’s One of Your Most Important Responsibilities
76. Learn To Be a Salesperson
77. Learn How To Learn from Bad Example
78. Remember Pierre Curie, Carl Wernicke, and Others
SECTION VI DISCOVERY
79. What Is Science?
80. No Single Theory Ever Agrees with All the Facts
81. There Is Only One Kind of Science, and That Is the Study of Everything with All Possible Methods
82. It’s Good To Be First, but It Is Not Necessary
83. You Don’t Need To Be Brilliant To Be a Researcher
84. Appreciate a Diversity of Approaches
85. Why Think When You Can Experiment?
86. Judge Every Project by Asking “What Difference Will It Make To Know the Answer?”
87. What Is Important in Research
88. Do Not Be Obsessed with Technology and Methods
89. Pay Attention to Study Design, Data Analysis, and Statistics
90. Be Aware of (Beware of ) Statistics and Data Torturing
91. Pay Attention to the Assumptions of Diagnostic Testing and Research Evaluations
92. It Is Possible To Be Productive from a Distance
93. You Can Make Contributions as a Clinician Without a Laboratory
SECTION VII ETHICS
94. Never Whisper in the Presence of Wrong
95. You Are Responsible for Your Actions; You Cannot Let Others Take Responsibility for You
96. The Need To Believe in the Guilty Victim
97. Compassion Is Part of Our Fundamental Nature
98. The Myth of Progress
99. Don’t Be Ageist