Diary of a (secondline) clinicianIt is well described that humans have multiple ways of thinking, one way of dichotomising these is into heuristic and analytic thought. Heuristic thinking is pattern recognition, once one has enough familiarity with a concept or circumstance one can immediately react appropriately to it without much further thought. This is like a brain reflex for when an immediate response is required. When a car is coming towards you down the wrong side of the road there's no need to think, it's time to run or jump out of the way. Analytic thinking is weighing up the pros and cons of various courses of action to decide on the best. Determining which courses to apply to study at university would be a good time to use this. "When a car is coming towards you down the wrong side of the road there's no need to think, it's time to run or jump out of the way" The heuristic thought mode is activated when time is of the essence such as when under threat or facing imminent danger. It's fast and where the situation is a familiar one, usually provides a good enough answer, based on experience. The analytic mode comes into its own when one has time and the consequences of the decision are significant, so an optimal decision is more important. It takes longer but is less likely to be biased by preconceptions and allows for a more complete consideration of the evidence. Healthcare professionals would do well to remember that in any medical context where one's health is at stake, but especially during a pandemic, patients feel under threat. Of course, this activates the heuristic thinking mode, where one doesn't have the brainspace to consider evidence. The fight or flight response activated, a brain simply wants to make a quick decision that will allow the body to escape the threat. No time for evidence and only one's prior experience to go on explains much of the otherwise irrational behaviour during trying times. "The analytic mode comes into its own when one has time and the consequences of the decision are significant" And so the great public health conundrum of how to pitch a message. At the mere suggestion of a new infection some anxious people are running for the hills while for others there would have to be bodies in the streets before they'd give up popping down to Dan Murphy's. Messages aimed at scaring the indifferent end of the spectrum into changing their behaviour are liable to induce panic in those at the anxious end. Similarly, when the public health information is attempting to calm panic-buying or mass flights away from infection epicentres, it runs the risk of overly reassuring those who need no extra reassurance. In the same way that those on the left and right of the political spectrum will interpret a news item in the most favourable way for their side of politics (a fact heavily exploited by news media), people will read into a public health message what they want to hear. Furthermore, it is impossible not to read into government policy and directives. - "The borders are closed and there's no pasta on the supermarket shelves, it must be the end of the world." - "The curve is flattening and hospitals aren't overwhelmed, there was nothing to worry about in the first place and all that social distancing has just screwed over the economy." I don't envy public health decisionmakers, almost as much as I don't envy politicians. If there was a way to target messaging to the individual that would be ideal, but well, we know how that worked out. So we are stuck with a heterogeneous public that must be simultaneously reassured and chastised. And all this to just the right degree to achieve the optimal overall pandemic response. A tall order indeed.
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