"Wait...What??!!" moments - Part 4

Let's flesh out cognitive load theory one further step. As physicians, we customarily use System I thinking as we go through our days. System I thinking is thinking on automatic, using heuristics, relying on patterns we have experienced over and over again. It is effective and efficient in most situations. When presented with information that doesn’t fit - or situations that disturb us - like someone insensitively interrupting a life-altering conversation - we have to switch to System II thinking which is more effortful, more conscious, and slower. Poised to proceed as planned, we are suddenly jarred to a different place.

Surgical literature has a term for these moments: slowing down when you should. When a surgeon begins a routine procedure and encounters aberrant anatomy, she slows down to inspect and proceed carefully, respectful of the new perils the situation may present. An attending surgeon assesses a trainee as to whether he appreciates the new situation, slows down, studies, and proceeds with care. Like almost all operations, many human interactions in the course of our days, require us to smoothly switch between System I and System II thinking. Some slow down moments are foreseeable, some not.

Slowing down when we should, switching between System I and System II, is a sign of expertise, of practice. Using what we have framed so far, we will next focus on a deliberate practice that helps us build the types of responses we want to Wait…What??!! moments. It may sound like you don’t have time for this. Bear with me. When we relate this to your professional ideals, it will become System I, automatic, a part of who you are, even when sleep-deprived or interrupted.