Lecture Notes: Strategies for Preventing Catastrophe

Personal Story

• Context: The speaker recounts an incident from a cold winter night in Montreal.
• Key Events:
  • Left keys inside the house.
  • Attempted to find alternative entrances; all locked.
  • Decided to break a window to get inside to retrieve important items for an early flight.
  • Realized forgot the passport after checking in at the airport, leading to a chaotic rush.
  • Ultimately missed the originally assigned seat and had to sit in less desirable conditions on an eight-hour flight.

Learning Experience

• Reflected on Stress Impact:
  • Adrenaline and cortisol can cloud thinking.
  • Realized the need for systems to prevent future catastrophes and minimize bad outcomes.

Introduction to Pre-mortem Strategy

• Concept Origin: Shared with the speaker by colleague Danny Kahneman, inspired by psychologist Gary Klein.
• Definition:
  • Pre-mortem: A proactive strategy where one anticipates potential negative outcomes and strategizes to either prevent or mitigate those outcomes.

Implementation of the Pre-mortem Strategy

Home Organization

• Designating Spaces for Important Items:
  • Use specific locations for things often lost (e.g., keys, glasses, passport).
  • The hippocampus helps track stable items; not as effective for movable items.

Travel Tips

• Secure Identification Information:
  • Take cell phone pictures of important documents (credit cards, passport) and store them in the cloud for easy access if lost.

Managing Stress in Medical Decisions

• Importance of Preparation:
  • Acknowledge that under stress, decision-making is impaired; preparations can help clarify thoughts.

Medical Decision-Making Example

• Cholesterol and Statins:
  • High cholesterol can lead to cardiovascular issues.
  • Informed choices about medications (e.g., ask about the number needed to treat (NNT)).
• NNT Explanation:
  • The number of patients required to take a treatment for one to benefit. E.g., 300 take statins for one individual to be helped.

Discussion of Side Effects

• Understanding Risk and Benefit:
  • Important to weigh the statistics on likelihood of benefit against potential side effects.
• Key Statistics:
  • Statin side effects occur in 5% of patients, meaning it's 15 times more likely to suffer side effects than to receive benefit.
  • Prostate surgery yields an NNT of 49 with a high incidence of side effects.

Key Takeaways

• Preparation is Key:
  • Anticipate potential failures and strategize accordingly.
• Recognizing Our Flaws:
  • Everyone can fail; the goal is to identify risk areas and create systems to reduce damage.
• Gradual Process Towards Organization:
  • The speaker acknowledges personal ongoing efforts to improve organization at home.

Closing Thoughts

• Focus on preventative systems and rational decision-making.

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