Lecture Notes: Premortem Thinking and Decision Making

Introduction

• Personal story about breaking into one’s own house in extreme cold.
• Reflection on stress and decision-making under pressure.

Key Experiences

• Midnight in Montreal: lost keys and extreme cold.
• Attempted to call a locksmith, but it would take time.
• Broke through basement window as a last resort.
• Woke up to realize I forgot my passport, rushed back home to retrieve it.
• Missed original flight, had to sit in a poor seat for an eight-hour journey.

Understanding Stress and Decision Making

• Cortisol:
  • Released in stressful situations.
  • Raises heart rate, modulates adrenaline, clouds thinking.
• Recognizing effects of stress on cognitive processes.

The Premortem Concept

• Developed by Danny Kahneman and Gary Klein.
  • Premortem: Anticipating potential failures before they happen.
• Comparison with postmortem analysis of disasters.
• Aim: Identify risks and develop preventive strategies.

Practical Applications of Premortem Thinking

Obvious Strategies

• Designate storage places for commonly lost items (e.g., keys, glasses):
  • Use the hippocampus effectively by keeping items in fixed spots.
• Travel preparedness:
  • Take pictures of important documents and store in the cloud.

Medical Decision-Making

• Example: High cholesterol and statin medication.
• Importance of understanding the Number Needed to Treat (NNT):
  • NNT for statins: 300 (one benefit for every 300 patients treated).
• Need to consider side effects:
  • Side effects in 5% of patients: muscle pain, gastrointestinal issues.
  • 15 times more likely to suffer from side effects than to benefit.
• Informed consent: Patients have the right to know risks vs. benefits.

Additional Health Considerations

• Prostate surgery as another example of NNT:
  • NNT is 49 for surgeries performed on men over 50.
  • 50% experience severe side effects.

Key Takeaways

• Prepare for high-stress situations in advance.
• Design systems and strategies to minimize failure and chaos.
• Understand the importance of quality of life in decision-making.
• Seek clarity in medical discussions to make informed choices.

Conclusion

• Acknowledgment of personal flaws in organization and decision-making.
• Gradual improvement towards better organization and preparation.