Lecture Notes on Premortem Thinking and Decision-Making

Introduction

• Personal anecdote about breaking into own house in extreme cold.
• Highlighted stress and its effects on decision-making.

Key Points from the Experience

• Cold winter night in Montreal, forgot keys inside the house.
• Broke window to enter house after failed attempts to unlock doors.
• Realized forgot passport only at airport check-in, leading to a stressful situation.

Premortem Thinking

• Concept introduced by Danny Kahneman, based on work from psychologist Gary Klein.
• Premortem: Anticipating potential failures before they happen to mitigate risks.

Comparison to Postmortem

• Postmortem: Analysis after a failure to understand what went wrong.
• Premortem: Forward-thinking approach to identify and prevent potential issues.

Practical Applications of Premortem Thinking

Establishing Systems

• Home Organization: Designate specific places for easily lost items (e.g., keys, passports).
  • Benefits from research on how spatial memory works, particularly the hippocampus.

Travel Preparation

• Take cell phone pictures of important documents (credit cards, licenses, passports) and store in the cloud.

Medical Decision-Making

• Importance of clear thinking when making medical decisions under stress.
• Example: Discussing cholesterol treatment (statins) with a doctor.

Key Statistic to Consider

• Number Needed to Treat (NNT):
  • NNT for statins: 300 people need treatment for one person to benefit.
  • Risk of side effects (5% probability) means 15 people may experience side effects for each benefit.

Ethical Considerations

• Medical ethics support informed consent; patients should understand risks vs. benefits.
• Importance of having proactive conversations with doctors about treatments.

Additional Considerations

• Common NNT in surgeries (e.g., prostate cancer surgery: 49 surgeries to help 1).
• Quality of life considerations: weighing shorter, pain-free life against longer life with potential pain.

Conclusion

• Acknowledgment of human flaws and the inevitability of failure.
• Importance of systems and strategies to mitigate risks and prepare for decisions.
• Personal follow-up: Installed a combination lock for future access to home, recognizing organization is a gradual process.