You are in your consultation room. You’ve done your homework. You’ve gathered your radiographs, exam notes, your study models, your photos. Now you’re waiting for Mrs. Peterson to arrive so you may present her treatment plan. Mrs. Peterson walks in, sits down, and smiles. You make pleasant conversation, and you begin. You make a clean, thorough presentation. She smiles, crosses her legs, nods, and asks relevant questions. You answer them professionally. Details are discussed - time and appointments needed, informed consent, alternatives, and financing.
“Well, Mrs. Peterson? When would you like to proceed? Are mornings or afternoons better for you?”
We and our patients make hundreds, if not thousands, of decisions each day - many insignificant, many consequential. How do we make those decisions? Many are made consciously after much deliberation. In our offices, we gather what we’ve learned from academia and past experiences, process that information, and make a logical decision. Our patients do the same through what they have learned and experienced - making their own thoughtful, deliberate, conscious decisions.
There is a second decision making strategy, however. It operates much more quickly below the level of consciousness. Malcolm Gladwell, in his book blink,* calls it “fast and frugal”. The part of our brain called the adaptive unconscious acts as a giant computer, quickly and quietly processing large quantities of information and making instant calculations before our conscious brain goes to work. We are thereby capable of making very quick judgments on very little information. We do this unconsciously when we meet someone for the first time, when we interview someone for a job, or react to a new idea. Our patients may similarly react to our treatment plans.
Society is generally skeptical of this kind of seemingly flighty cognition. We assume the more time and effort taken in making the decision, the better the decision. Doctors order more tests in offering a diagnosis. Patients seek second opinions. We teach our children - haste makes waste, look before you leap, stop and think, don’t judge a book by its cover. We trust only exhaustive, meticulous decision making. However, snap decisions and first impressions, studies demonstrate, are often every bit as accurate as decisions made more cautiously.
This rapid cognition Gladwell calls “thin-slicing”. It is our brain’s ability to quickly “find patterns in situations and behavior based on very narrow slices of experience.”* At Mrs. Peterson’s consultation visit, for example, let’s say you do not listen to her concerns. Perhaps you talk down to her and do not treat her respectfully. Mrs. Peterson will listen to her gut feeling and not accept treatment. That is thin-slicing. She is unconsciously drawing on her previous experience of others treating her similarly and how she felt then and rapidly making her decision from that.
Thin-slicing is a central part of being human. We thin-slice because we have to, particularly during times when it’s crunch time - when we don’t have time to deliberate. Basketball players call it “court sense”. We may call it “street smarts”. It is a mysterious phenomenon. We need to accept the fact that it is possible to know something without knowing.
Please e-mail us at firstname.lastname@example.org or fax us at (612) 339-3618. We look forward to hearing from you not only regarding this article, but also if you have any ethical dilemmas you would like to present to the membership. Perhaps we can help you decide what to do.
*Dr. Churchill is Chair of the Minnesota Dental Association’s Committee on Ethics, Bylaws, and Constitution. He is a general dentist in private practice in Minneapolis, Minnesota.
** From blink, The Power of Thinking Without Thinking, by Malcolm Gladwell. New York, NY: Back Bay Books/Little, Brown and Company, 2005.