Lecture Notes: Managing Stress and Decision Making

Introduction

• Personal story of breaking into own house during winter in Montreal.
• Importance of preparation and systems to mitigate potential disasters.

Experience Overview

• Midnight drive home, discovered lost keys inside the house.
• Tried to access house through all doors and windows; all locked.
• Considered calling a locksmith but decided to break in through a basement window instead.
• Realized next morning that I forgot my passport, causing travel delays.

Understanding Stress and Decision Making

• Stress causes the brain to release cortisol which:
  • Increases heart rate.
  • Clouds thinking.
• Personal anecdote about forgetting passport highlights how stress affects cognitive functions.

The Concept of Prospective Hindsight

• Introduced by Danny Kahneman, also known as a pre-mortem.
• Postmortem: Analyze what went wrong after a failure.
• Pre-mortem: Anticipate potential failures and develop strategies to prevent them.

Practical Applications of Pre-mortem

Home Organization

• Designate specific places for easily lost items (e.g., keys, reading glasses):
  • Hooks by the door.
  • Specific drawers for passports.
• Importance of spatial memory and the role of the hippocampus in locating items.

Travel Preparation

• Take cell phone pictures of important documents (credit cards, ID, passport).
• Email images to self for easy access if lost.

Medical Decision Making

• Importance of being prepared for medical discussions, especially under stress.
• Example: cholesterol management and statin prescriptions.
  • Number Needed to Treat (NNT): Number of patients needed to be treated for one to benefit.
  • Most widely prescribed statin: NNT = 300 (for one heart attack or stroke prevented).
  • Side effects occur in 5% of patients; weigh benefits vs. risks.

Importance of Informed Consent

• Patients have the right to understand risks and benefits before agreeing to treatment.
• Example: Prostate removal surgery;
  • NNT = 49; significant side effects (50% risk).
• Quality of life considerations should be made before decisions.

Conclusion

• Acknowledge that everyone can fail; the goal is to prepare for potential failures.
• Implement systems to prevent mistakes or minimize their impact.
• Personal takeaway: Installing a combination lock for better access to home without keys.
• Ongoing journey toward better organization.

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Key Takeaways:

• Plan ahead and create systems to prevent potential disasters.
• Understand the effects of stress on decision-making processes.
• Engage in pre-mortem thinking for better outcomes in personal and medical decisions.