Thinking Fast Is Clinically Important, but Thinking Slow ...

1 E426 Copyright SLACK IncorporatedEditorialDuring a Grand Rounds presen-tation a couple years ago at The University of Chicago s Comer Children s Hospital on under-standing and using big data in the pedi-atric intensive care unit, Dr. L. Nelson Sanchez-Pinto, who was a pediatric intensivist at the hospital at the time, mentioned a book by Daniel Kahneman entitled Thinking fast and The basic principles involve the idea that people think using two systems: Sys-tem 1, an automatic fast system with a quick response to a question that gen-erates patterns of ideas based on innate skills and experience, such as clinical impression or judgment; and System 2, a slow system that provides the abili-ty to work through an effortful, complex series of thoughts and computations that require attention, such as gathering fur-ther clinical data toward a working clin-ical the practice of medicine, especial-ly when caring for infants and children who are acutely ill, we use System 1 fre-quently in the emergency department, intensive care unit, and sometimes in the clinic or office.

2 I learned and still tend to think that airway, breathing, and circulation in children as a respiratory event is the most common cause of an out-of-hospital arrest; however, we are now learning in practice that it should be cardiac, airway, and When using System 1, as described by Kahneman,1 in our initial management, patients are stabilized, we gather more history, conduct serial physical exami-nations, and assess initial laboratory results (ie, blood gases, electrolytes, glucose, calcium, magnesium). System 2 enables us to further analyze and syn-thesize the clinical information we have requested and possibly revise our work-ing diagnosis and management.

3 System 1 Thinking gets us started, but System 2 Thinking is every bit as important in the formulation of our working diagnosis and management. I thank Dr. Sanchez-Pinto for his refer-ence to Kahneman s book, and even though this approach is primarily de-signed for work in the economic sci-ences, it is relevant to how we think in clinical medicine. In addition, Dr. Sanchez-Pinto uses the discussion of the two systems in his teaching and examines them in a recent review about big data in the critical care The more I have learned about System 1 and System 2, the more I think it applies to everyday Thinking in our own lives. REFERENCES 1.

4 Kahneman D. Thinking fast and slow . New York, NY: Farrar, Strauss and Giroux; 2011 2. Marsch S, Tschan F, Semmer NK, Zobrist R, Hunziker PR, Hunziker S. ABC versus CAB for cardiopulmonary resuscitation: a prospective, randomized simulator-based trial [published online ahead of print September 6, 2013]. Swiss Med Wkly. 3. Sanchez-Pinto LN, Luo Y, Churpek MM. Big data and data science in critical care [pub-lished online ahead of print May 9, 2018]. Chest. fast Is Clinically Important, but Thinking slow Is Just as ImportantJoseph R. Hageman, MDPediatric Annals Editor-in-Chief Joseph R. Hageman, MD, is the Director of Quality Improve-ment, Section of Neonatology, Comer Children s Hospital; a Senior Clinician Educator, The Univer-sity of Chicago Pritzker School of Medicine; and an Emeritus Attending Pediatrician, NorthShore University HealthSystem.

5 Address correspondence to Joseph R. Hageman, MD, via email: I thank Patricia Lee King, PhD, (State Project Director of the Illinois Peri-natal Quality Collaborative) for her thoughtful review and contributions to this editorial.