Kotov syndrome: does it occur in medicine?

[SpaceDementia]

http://en.wikipedia.org/wiki/Kotov_syndrome

In chess, Kotov syndrome is a phenomenon first described in Alexander Kotov's 1971 book Think Like a Grandmaster. It occurs when a player thinks very hard for a long time in a complicated position, but does not find a clear path. The player then notices he is running low on time, and so quickly makes a move, often a terrible one that was not analyzed at all, and so loses the game. Once so described, many players have agreed that the process is very common.

Pretty fascinating, if you ask me. It's been characterized in chess players, but does this behavioral tendency also occur in other fields, like medicine/surgery? I think it would be unlikely, and you'd hope not, because a human life is so much more important than a chess match. On one hand, the physician is prepared enough to prevent it from happening... but on the other hand, certain procedures do entail time constraints as well as complicating and unforeseen factors that may arise from operating on a human body (i.e. the unpredictability of the other chess player's move). Opinions?

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[adeline]

yes

sry2say

 

[not so calm now]

No research on it. There you have your thesis. Now start data collection!

 

[TopSecret]

http://en.wikipedia.org/wiki/Kotov_syndrome

Pretty fascinating, if you ask me. It's been characterized in chess players, but does this behavioral tendency also occur in other fields, like medicine/surgery? I think it would be unlikely, and you'd hope not, because a human life is so much more important than a chess match. On one hand, the physician is prepared enough to prevent it from happening... but on the other hand, certain procedures do entail time constraints as well as complicating and unforeseen factors that may arise from operating on a human body (i.e. the unpredictability of the other chess player's move). Opinions?

Of course. It's human nature. But this is why you have redundancies and safety measures built into the health care system (most of the time).

So if one person has a 0.01 probability of failure for a given task and two people are assigned to complete that same task the probability of both failing the task is 0.01 x 0.01 or 1/10000. If three people are assigned to complete the task then the probability of failure is 0.01 x 0.01 x 0.01 or 1/1,000,000.

 

[armybound]

I don't know if physicians would think that intensely about a problem and not be able to come up with a solution. I'd imagine you either have a clue what to do, or you come up totally blank and just do something.

 

[TopSecret]

I don't know if physicians would think that intensely about a problem and not be able to come up with a solution. I'd imagine you either have a clue what to do, or you come up totally blank and just do something.

First, do no harm. Many times not doing anything is the best solution and that's what a lot of doctors do except they document "observe" or "monitor" in the chart and recommend close followup or refer the patient to a specialist.

 

[armybound]

First, do no harm. Many times not doing anything is the best solution and that's what a lot of doctors do except they document "observe" or "monitor" in the chart and recommend close followup or refer the patient to a specialist.

Note that the second part of Kotov is being pressured to make a decision in a limited amount of time. Imagine a trauma in the ED, not the typical floor patient.

 

[johncalvin]

Reminds me of my MCAT experience...lol

 

[Mattabet]

Reminds me of my MCAT experience...lol

Lol. Also, I'm really glad this 'syndrome' isn't named after me. Poor Kotov, whomever he was, makes one bad move in chess...

 

[TopSecret]

Note that the second part of Kotov is being pressured to make a decision in a limited amount of time. Imagine a trauma in the ED, not the typical floor patient.

That's where risk management comes in. The department might need to hire more qualified people to cover all sorts of contingencies.

 

[Compass]

DOES IT?

My friend dropped an entire KIDNEY on the floor in Trauma Center on the Wii because that happened XD. Luckily, I'm the one going into medicine, not him

 

[adeline]

That's where risk management comes in. The department might need to hire more qualified people to cover all sorts of contingencies.

........
i call on your status.

 

[TopSecret]

........
i call on your status.

Why? It's true. The hospital provides the ER doctors with malpractice insurance. It is in their best interest to provide the safest care possible (while making a decent profit on the side).

 

[SpaceDementia]

Reminds me of my MCAT experience...lol

Hah... yep, this most certainly applies to the MCAT.

Note that the second part of Kotov is being pressured to make a decision in a limited amount of time. Imagine a trauma in the ED, not the typical floor patient.

Exactly. That, or a time-sensitive surgery.

 

[adeline]

Why? It's true. The hospital provides the ER doctors with malpractice insurance. It is in their best interest to provide the safest care possible (while making a decent profit on the side).

The things you say, I do not think they mean what you think they mean.

 

[TopSecret]

The things you say, I do not think they mean what you think they mean.

In what way? Explain.

 

[boaz]

http://en.wikipedia.org/wiki/Kotov_syndrome

Pretty fascinating, if you ask me. It's been characterized in chess players, but does this behavioral tendency also occur in other fields, like medicine/surgery? I think it would be unlikely, and you'd hope not, because a human life is so much more important than a chess match. On one hand, the physician is prepared enough to prevent it from happening... but on the other hand, certain procedures do entail time constraints as well as complicating and unforeseen factors that may arise from operating on a human body (i.e. the unpredictability of the other chess player's move). Opinions?

I don't understand the analogy. Do you play timed chess? If the players are playing a "30-minute game" it means that each player has a grand total of 30 minutes to think throughout the whole game. Often the position is so complicated that you get lost in your thoughts and lose your sense of time. By the time you look at the clock there's very little time left and you have very little time to think before the subsequent moves. Surgeons, under normal circumstances, can only be praised for being so focused as to lose track of time.

I get the sense that what you really mean is simply the tendency to make mistakes when under time constraints, like during the MCAT ... or, more importantly, in a surgical patient under cardiac arrest. Humans being humans, one can only assume that the surgeon does his/her very best to avoid mistakes.

Come to think of it, shouldn't training in blitz chess be a prereq for med school?

 

[Depakote]

As a correllary to the above... I've recently been introduced to the 50-50-90 rule on rounds.

Pimp a med student with an easy 50-50 question, there's a 90% chance he'll get it wrong.

 

[redsquareblack]

http://en.wikipedia.org/wiki/Kotov_syndrome

Pretty fascinating, if you ask me. It's been characterized in chess players, but does this behavioral tendency also occur in other fields, like medicine/surgery? I think it would be unlikely, and you'd hope not, because a human life is so much more important than a chess match. On one hand, the physician is prepared enough to prevent it from happening... but on the other hand, certain procedures do entail time constraints as well as complicating and unforeseen factors that may arise from operating on a human body (i.e. the unpredictability of the other chess player's move). Opinions?

It's an interesting idea, but I suspect physicians are largely trained to think in terms of algorithms, ultimately with an eye toward "Blink"-type, rapid-assessment decision-making. Seems to me that medical training is largely geared toward automation of thought process. Could be wrong, tho.

 

[lstone13]

Reminds me of my MCAT experience...lol

That is exactly what I was thinking. And I figure I did make many wrong choices at the last minute. Ugh.

 

[sportsfreak]

man this brings back some memories...

state championship, 1st place going into last round, spent 40 min thinking about a move, then made a horrible move on impulse and went downhill form there

had no idea there was a whole topic about this

 

[45408]

It's an interesting idea, but I suspect physicians are largely trained to think in terms of algorithms, ultimately with an eye toward "Blink"-type, rapid-assessment decision-making. Seems to me that medical training is largely geared toward automation of thought process. Could be wrong, tho.

I agree with this. There are certainly ways to go wrong in a trauma situation, but generally speaking, things follow a fairly set procedure. The most aggressive move may be the wrong one (e.g., dashing off to the OR), but it's not too likely that you'd kill a patient by doing that rather than doing nothing.

I disagree with your comment about "automation of thought process." That's not really the case outside of trauma/emergency/ACLS situations.

 

[redsquareblack]

I disagree with your comment about "automation of thought process." That's not really the case outside of trauma/emergency/ACLS situations.

Oh, don't misunderstand me. I'm not saying that physicians become thoughtless automatons, but rather that the extensive training that doctors undergo is geared toward exposing them to a vast number of situations and contingencies, repeatedly. I suspect this is in order to increase one's familiarity, and decrease surprises, so that responses become more automated.

This isn't to say that there's no room for inventive thinking.

 

[planktonelement]

I've been feeling this way on practice MCAT questions. Usually the answer is the simplest and most obvious.

But for surgeons, I don't think it'll happen as much. I agree with redsquareblack on this one. Even though the human body is unpredictable, it's not as unpredictable as the human mind.