One Black Swan

Premature Closure: a type of cognitive error in which the physician/healthcare team fails to consider reasonable alternatives after an initial diagnosis is made.

During our previous sessions, I was struck by the profound effect premature closure has had on the lives of the few personal stories we have heard. In the field of aviation, confirmation bias, or looking for what you think you should see, has caused multiple crashes and near misses. All around, confirmation bias and premature closure are such risky mindsets.

I was reminded of Nassim Taleb’s theory. When you think of a typical swan, you probably think of a long-necked, white, elegant creature. From there, let’s say we theorize “all swans are white”. We could go to hundreds of different parks and ponds and lakes in America and find thousands of white swans to support our claim, but Taleb argues that is a form of confirmation bias, and to truly solidify our theory, we need to search the world over for the potential one black swan that could disprove us.

Taleb defines a “black swan” as any unpredictable, yet high impact event. We see these daily in the medical field, and even have the clever reminder to second guess any potential black swans-
“When you hear hooves, think horses, not zebras”-
and while there is some truth to this, we cannot rule out the zebras. Our patients lives depend on us pausing to consider donkeys and Shetland ponies and antelope and everything in between, even when we feel confident we have our equids figured out.

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