The Ordeal 3--Summary

“Cancer patient, Jay, and his devoted wife, Ann, have begun six days of in-patient chemotherapy in a different hospital.  Hopefully, they will not be subjected to any hospital screw-ups that we’ll want to discuss.”

“So we’re done for the day?  I’m outta’ here.”

“Nicht so schnell, Julie!  We’ve still got work to do.”

“Based on the tone of your voice, Curmudge, I perceive that you just said ’Not so fast’ (in German).”

“Right as usual.  As we promised last week, we’ll summarize what we learned from Jay and Ann’s ordeal.  In addition, we’ll provide some unsolicited suggestions that the original hospital (which will remain anonymous) needs to consider.  Let’s start this way: Julie, if a hospital said that they were providing patient-centered care—and most of them say that—what would you, as a patient, expect?”

“First of all, if I were in severe pain, I would expect the hospital to do everything feasible to alleviate it.  Nothing else matters to one experiencing intractable pain.  If I had nausea or constipation or other physical discomforts, I’d expect help there too.  Also, I would consider a noisy environment to be a physical discomfort.  Finally (but definitely not least), the hospital should minimize the patient’s and family’s emotional stress.  Not knowing, waiting, or poor communication in general would be almost as bad as pain.  Things often not known would include one‘s diagnosis, when the next test will be and when its results will be available, and when one will be able to eat.  If a hospital can’t communicate with its patients, its supporting elements like clinics and pharmacies, and within itself, it might as well be a cottage industry in Kyrgyzstan.”

“Well put, Julie.  And at some point during Jay and Ann’s ordeal, they experienced each of the above.  The biggest issues at the first hospital were emotional stress and communication problems, which started with the computer hang-up in getting Jay admitted.  Then there were the almost non-existent communications between the hospital and pharmacy.”

“I was really concerned about Jay’s having to wait a day—in pain—for a CT scan and then overnight for the result.  CTs are run 24 hours a day in most hospitals, and there are services that read them overnight.  Of course, Jay, Ann, or nurses in the hospital should have stayed abreast of the constipation problem before it became serious.  Most everyone knows that narcotic painkillers cause constipation.”

“On the other side of the ledger, I was impressed by the on-call oncologists who answer the phone at 2:30 a.m.  It’s amazing that they can be alert and give sage advice to someone who might not even be their patient.”

“So, Curmudge, what’s the bottom line?  The original hospital seems to have a peck of systemic problems.”

“Julie, my one-word answer is the same as it has been for the past six years.  Lean! The hospital needs a Lean transformation.  Anyone who is not acquainted with Lean can start with the first Kaizen Curmudgeon posting in May of 2007 and read the next 240.  In a nutshell, the hospital needs to empower the employees to map their processes, find the root causes of problems, and then use plan, do, study, act cycles to implement continuous improvements.  They need to find the waste and inefficiencies in their systems and get rid of them.  And finally, the hospital must do this with the full support and leadership of management at every level.  If Jay and Ann’s first hospital has already started a Lean journey, it needs more attention.”

“That was a pretty concise rant, Curmudge.  If a hospital can get its systems in order, they should be well on their way to providing patient-centered care.  So what kind of problem will we illuminate—but not resolve—next?”

 

“We’ll take a break for a couple of weeks, read some books, and then present some stuff about a little-known issue that a few readers might not believe.”

“Sounds interesting.  I’m with you, Old Guy.”

Kaizen Curmudgeon

The Ordeal 2

Another tough week, but are screw-ups subsiding?

“Curmudge, a newby who just surfed into this posting would have no idea what we are talking about.”

“That’s the way it is in blogs and in life, Julie.  It’s difficult to put today into context without knowing what went on yesterday, or last week.  But we can’t wait for stragglers.  Time to proceed onward.”

“I understand, Old Guy, that Ann became a ‘frequent flyer’ at the local pharmacy.  Quoted below are some of her comments:

‘Needed several new medications. Local pharmacies do not carry some of the specialized ones; they have to be ordered.  One special one to prevent infection would have cost $3,200!  We did not get it filled.  It had to be ordered from somewhere.  I called the clinic early this afternoon to learn if there is an alternative but have not heard back yet.  Having to run to the pharmacy daily is frustrating—especially with back orders, meds not in stock, or unusual drugs.  Wish there were a better system for cancer patients. The clinic does not stock samples of drugs.  Some days it's multiple trips to the same pharmacy.’

‘Jay had a strong drug reaction that lasted an hour during an outpatient chemo infusion that took 8 hrs last Thursday, and a Neulasta injection that produced severe flu-like aching—very painful. Plus other painful side effects: mouth sores, bad stinging and pain in jaws and throat. Incredible fatigue.’

‘I asked the pharmacy to call as soon as they got the Vicodin order (for pain), and they called us back to say it was ready. Then they also texted Jay's phone.  Nice.  I made friends with the pharmacist today; told them all I'd be a "frequent flier" and that Jay was enduring aggressive chemo. I think they will be ready-on-the-spot now since they know we need help. They were great about the Vicodin—usually that one can't be called in.’ “

“The situation at the pharmacy end of the system seems better, Julie, but things are still messed up at the hospital end.  This is what Ann wrote:

‘Any e-filing or phoning of prescriptions from the hospital side to our pharmacy has not worked.  I asked where the disconnect is occurring, but I’m not sure I got an answer.  I called the clinic to get a prescription, and they said I had to talk to the hospital medical unit.  After four phone calls to the hospital last Friday afternoon, the clinic finally just did the Rx—and phoned it in. The hospital never did do it in spite of three calls from me to the 3rd floor medical unit (they promised it was done, each time I called) and two calls from the clinic to the medical floor!  The clinic staff told me the staff on the hospital floors don’t like to phone in prescriptions.  Nice, huh?  Then why don't they just hand me a written script then?’ “

“Wow, Curmudge!  As in the Book of Job, it seems that trouble keeps coming:  

‘It’s 6 a.m. and Jay was up all night throwing up.  At 2:30 am I called the on-call doc. She said to come right into the clinic at 8 a.m. What a long night.  No sleep again for Jay. It may be a bowel obstruction.’

‘It’s 11:30 am, and he still feels crappy; blocked up. The x-ray showed a mass in Jay’s abdomen. He must have a CAT scan for a better view.  Jay will be an inpatient for the day and tonight.’

‘The CAT scan—where is it?  It was ordered at 11:30 am.  Jay is not able to have any food or water due to the blockage, and he's extremely uncomfortable with nausea. The RNs gave him meds that helped. But the doctor still doesn't know what the problem is.’

‘Jay waited all afternoon; but by 5 pm, still no scan.  Where's the CAT scan? Then we will have to wait for a radiologist to read it.  Now the business day is over, and Jay has a serious blockage that hasn’t been identified.’

‘My patience is wearing thin with delays at the hospital.  Jay has been through hell. The clinic staff and on-call folks have been wonderful—responsive, caring, and attentive, but there seem to be snags at the hospital diagnostic level again.  Where's the urgency with a cancer patient?’

‘Jay just sent a text: He just got back from the CAT scan at 5:45 pm.—6 hours late. He said the CT folks were swamped with ER cases today.  As expected, results will not be available until tomorrow.’

‘Next day: The CAT scan showed that the mass is severe constipation from the GI system’s shutting down due to electrolytes being out of balance.  Electrolytes via IV are starting to wake up Jay’s GI system.’ “

“Curmudge, might some of those ‘urgent’ scans in the CT backlog have been defensive medicine?  And I’m surprised that there wasn’t a radiologist on call.”

“With a name like yours, Jaded Julie, I would not be shocked by your having suspicions.”

“So where do we go from here, Professor?”

“It depends, chère étudiante.  If delays and screw-ups have really subsided, next week we’ll summarize what we’ve learned.  And you and I, who probably aren’t qualified to make recommendations, might make some anyway.”

Kaizen Curmudgeon

The Ordeal 1

The First Week—Further Diagnosis and Follow-Up

“Prepare, Jaded Julie, to be dismayed, disgusted, and disheartened by today’s discussion.  Every cancer patient’s experience is an ordeal; some are quite tolerable, but some are horrible.  We are going to discuss one that started out in the horrible category.”

“Curmudge, I sense that you are in a black mood that can only be assuaged by feeding it to the computer, pressing the ‘save’ button, and ultimately posting it on our Kaizen Curmudgeon blog (http://kaizencurmudgeon.blogspot.com).  So how are you and I going to tackle this?”

“To maintain our focus on Lean management systems in health care, we will pluck the organization’s systemic problems from the patient’s experience.  Most of these first- and second-order ‘screw-ups’ will be described by quoting the patient’s spouse.”

“Screw-ups, Curmudge!  Those are harsh words coming from an ancient but dignified professor.  We know that hospitals work hard to avoid ‘never’ events, wrong site surgeries, surgical site infections, and medication errors, but it’s the seemingly minor and more frequent screw-ups, as you describe them, that make life miserable for patients and their families.”

“Patient-focused care doesn’t always happen, Julie.  Here’s the story.  My close friend, Jay (not his real name), was diagnosed with Burkitts lymphoma quite recently.  In fact, the full extent of the disease has not yet been determined.  In any case, it will be treated quite aggressively beginning with a week as an inpatient in a hospital outside the immediate Fox Valley.  Jay’s wife, Ann (not her name either), has been providing daily updates to friends and family.  Quoted below with her permission (and with some editing) is how she described Friday:       

‘Jay is finally an inpatient after a snafu that took all day.  The morning began with a PET scan.  Then at noon we got lots of our questions answered at the oncology clinic.  The PET scan results were not what we hoped.  There is mall lymph involvement in Jay’s chest—only 1 cm more than normal but still there in two little places.  The spinal test still has to come back.’

‘We then walked over to Inpatient, but there were no orders, not even an order for food. Poor starving Jay; he has had nothing to eat since yesterday.  Our hope was to get a jump-start on treatment today.  The orders got lost between the oncology clinic and the hospital, which incidentally are in the same building!  Orders had to be re-done—followed by lots of apologies.  Apparently the problem was the staff’s unfamiliarity with their new computer system.  But we still lost a day of treatment.   Jay is just now getting settled in at 7 p.m.  We were there all day!’ “

“Now I understand your blue funk, Curmudge.  What a horrible way to treat the patient and his family who are already under a level of stress that neither of us can fully appreciate.  It was unconscionable!  So how might a hospital avoid these situations?”

“Every hospital knows its own system best, and some may have their screw-ups under control.  Those that do not will need a person or persons with strength to walk through the hospital’s silo walls and the stature to be heard when he or she speaks.  It’s critical that these problems be nipped in the bud, so patients will need to know whom to contact when things appear to be going awry.”

“So what do you foresee in Ann’s next report, Curmudge?”

“It’s time for some good news, Julie, so I remain hopeful.  Many years ago Jay and Ann and I hiked together in the Rockies, and I want to do it again.”

Kaizen Curmudgeon

Bloggers--Affiliated or Independent

“Hey, Curmudge, with respect to both kinds of bloggers, we’ve been there and done that.  We spent most of five years affiliated with an organization, and it has been several months since the old man’s cubicle was dismantled and we became independent.  But why should anyone be interested in the life and times of a blogger?  To most readers, a blog posting is simply a few paragraphs of either valuable or useless information written under someone’s real name or nom de plume.”

“The biggest reason, Julie, is because we are different.  Most blog writers are real people practicing real professions who write declarative sentences.  You and I are fictional people, and our author is a senior citizen writing conversational

sentences in an old folks home.  And we’re an excellent example of symbiosis; the old man does the thinking and we do the talking.”

“Sounds as if we might have a story.  Let’s start by describing how an affiliated or institutional blogger differs from someone in the marketing department.  Although they are both producing copy viewed as representing the organization, the work of the marketing person is directed at customers while the blogger’s postings are directed at anyone willing to read them.  The blogger’s post is signed (sort of), while marketing stuff simply emanates from the department.”

“Here, Julie, is another way to describe an affiliated blogger.  He or she might be regarded as similar to a columnist on the editorial page of a publication.  The columnist provides research and observations to support an article, but the tenor or the piece must not violate the publication’s mission statement.  And speaking of research, the blogger can study and summarize topics of interest to colleagues and to the organization.  A librarian tells ‘where it is,’ and the blogger tells ‘what it says.’ “

“And finally, Curmudge, like any material written for public consumption, the draft postings of an affiliated blogger should be edited for content, grammar, and to assure conformity with corporate policy.  That should not be difficult, because blog postings are usually not over two pages long.”

“You know, Julie, we both had a great time being affiliated bloggers.  And our 200 postings on Lean, leadership, and health care are out there in the blogosphere for anyone to read.”

“So what’s different about being independent, Curmudge?  I suspect that your answer will be ‘everything.’ “

“A big difference is that we don’t have formal or implied constraints.  That was and still is not a practical issue, because the old man continues to insist that we use good taste in what we discuss.  Now, however, we don’t hesitate to tackle a controversial topic or mention a good publication written by what used to be a competitor.”

“What about the venue where the work is done, or ‘gemba’ in Lean parlance?  It used to be a cubicle in a big room in an office building.  Now the old man’s office is in his bedroom in an apartment.”

“Well Julie, the old man’s ‘cube’ wasn’t too bad unless a neighbor was on the phone.  Otherwise, the room’s background noise was just a low hubbub—fairly conducive to reading, thinking, and writing.  He was used to that after 60 years working with people either in a classroom, lab, or office.  Now, although the apartment is everything one would want, it is as quiet as a tomb.  Although most people would like a little peace and quiet for writing, this is extreme.  Of course, there can be no camaraderie or exchange of ideas in a solitary workplace.  But the old man is getting used to it.”

“I suspect that there are other practical disadvantages for a blogger in isolation.  Being ‘out of touch’ means that local concerns and issues can’t be addressed in the blog.  An independent blogger would be unable to function without the Internet, but then again, there wouldn’t be web logs without the web.  So, Curmudge, what will the old man do in the future, and what will happen to us?”

“I suspect that we will look farther afield for topics to discuss, and the old man will do what we discussed on June 3, 2012.  He will remain an inveterate teacher and will ‘keep on a-keepin’ on’.“

Kaizen Curmudgeon           

          

Risks and Fears 3

The Old Risks and Benefits File

“I found it, Julie!  My old Risks and Benefits file.  Most of the papers in it are dated from the early 1990’s.”

“To you, Curmudge, that must seem like yesterday, but it was 20 years ago.  Has people’s judgment about risks improved much since then?”

“No, but human nature hasn’t changed much either.  Everyone still wants to live a risk-free life, and they still look up when someone comes along shouting, ‘The sky is falling.’  Then nongovernmental organizations (NGO’s) smell money to support their causes and conjure up data to show that a disaster is imminent.  Instead of ‘evidence-based policy-making, we have policy-based evidence-making’ (1).  Finally, Chicken Little is awarded a Nobel Prize.”

“So, Curmudge, what did the old file reveal about risk issues in the early ‘90’s?”

“Julie, they lay at the intersection of chemical analysis sensitivity, determination of carcinogenicity, regulatory agencies, and NGO’s.  We mentioned the sensitivity issue in our first posting in this series.  The finding of the growth regulator, Alar, in applesauce and apple juice got the most publicity in 1989.  One woman even called her local health department to find out if it was safe to pour apple juice down the drain.  With the aid of Google, we could discuss these issues for weeks.”

“Also in your old file is an article describing the work of Bruce Ames (2).  To quote Ames, ‘Most carcinogens and other known toxins are not man-made.  In fact 99.99% of the “pesticides” we consume occur naturally in plants, nature’s attempt at protecting them from being eaten.’ “

“And, Julie, Ames also said, ‘Our bodies don’t care whether a chemical is synthetic or natural.  At low doses we have these elaborate defense systems that work the same way for both.’  ‘There are more “known carcinogens” in (my) morning cup of coffee than in the pesticide residue on food one could comfortably eat in a year.’ “  

“Well, Old Guy, you’ve never been a ‘natural’ food zealot.  How do you feel about the use of growth regulators and pesticides in agriculture, specifically in the apple orchard?”

“I trust that you recall this old story: What’s worse than taking a bite out of an apple and finding a worm?”

“I know, Curmudge.  It’s finding half a worm.  I guess that answers my question.”

“So Julie, is there anything else that you have found of interest in my old file?  The papers may be 20 years old, but the information might be ageless.”

“You have collected examples to illustrate just how small analytical detection limits had become even 20 years ago.  You also have data on relative risks.  Let’s conclude today’s discussion by sharing some with our readers.”

“Okay Julie, here goes:

A part per trillion is:

One second in 32,000 years.  Expressed differently, if one counts back in time for one trillion seconds, the year will be 30,000 B.C.  (Check this; it’s easy.)

One flea per 360 million elephants.

One 6-inch banana in a line of 6-inch bananas from the earth to the sun.

A pinhead would occupy one trillionth of the surface of a road (how many lanes?) from New York to California.”

“Here are some factoids regarding equal risks.  Each of the examples would reduce one’s life expectancy by eight minutes:

Smoking 1.4 cigarettes.

Eating 40 tablespoons of peanut butter.  (Perhaps due to aflatoxin in a fungus on the peanuts.)

Traveling 300 miles by car or 6 minutes by canoe (in grade III rapids?).”

“Enough, enough!  Let’s take a week off and check the banana illustration.  By the way, Curmudge, if you had a trillion dollars, would you know how to spend it?”

“No way, Julie!  Only politicians know that, and they spend other people’s money.”

Kaizen Curmudgeon           

(1)   Ridley, Matt  Cooling Down the Fears of Climate Change.  Wall Street Journal, December 19, 2012.

(2)    Spencer, Leslie  Ban all plants—they pollute.  Forbes, October 25, 1993.       

Risks and Fears--Examples

“Curmudge, have you used up your supply of vignettes like the one last week where I was chased by a bear?”

“No problem, Julie.  You’ll always be safe if you hike with someone who can’t run as fast as you.  But I can assure you that we are past the technical stuff and will just talk about situations where people don’t have their head on straight regarding risks and fears.”

“And as usual, you’ll start with a tale from long ago.”

“I grew up in Ohio a half-mile from a coal-fired power plant that belched a plume of smoke and fly ash 24/7.  Everyone knew that that stuff was not good for our lungs, but the plant had always been there, and we liked having electric lights.  When I visited the area a few months ago, the plant was four times its original size with much better emission controls.”

“But why, Curmudge, didn’t they put in a nuclear power plant when more capacity was needed?  There wouldn’t have been any air pollution at all.”

“If one had been considered (and it probably wasn’t), the locals would likely have opposed it.  They would have been fearful that some sort of disaster would release high-level radiation, and that low-level radiation from daily operations would produce chronic health problems like cancer.  (More on this in later postings.)  However, a better-informed person would have realized that a disaster from a Japan-type tsunami is extremely unlikely on Lake Erie.  And furthermore, radiation from the power plant at my former residence would have been insignificant compared to natural background radiation.”

“So this, Curmudge, is an example showing where a perception gap could lead to a less-healthy choice.”

“Right, Julie.  Here’s another close-to-home example.  Both Al and Mack have phones in their cars.  They use headphones so they can have both hands on the steering wheel.  Have they reduced their biggest threat?  No, because their biggest threat is mental (1).  We’ve said it before; the mind can’t concentrate on two things at the same time.  I proved that to myself by listening to language tapes as I drove to work.  I couldn’t concentrate on learning while driving safely.  Incidentally, Al and Mack accept and feel they can control the risk of driving and talking.  And Mack accepts the risk of sometimes riding a motorcycle (while wearing a helmet), but control of this risk is in the hands of nearby people driving cars.  The point is that a risk is unchanged whether one accepts it or not.”

“Wow, Curmudge!  I share your concern.  So what about the people’s perception of risk from trace chemicals in the river that you mentioned at the top of the preceding posting?  My guess is that a psychologist would not have changed people’s minds, but he would have better understood the bases of their concerns.”

“Right again, Julie.  The chemicals were presumably man-made, new and unknown to the populace, provided no benefit, were toxic at some uncertain level, and the people did not choose that they be put in the river.  Furthermore, the people didn’t trust the guy saying, ‘Not a problem.’  Ultimately, processes were changed to avoid producing the trace chemical as a by-product.  If the problem had persisted, a nongovernmental organization would likely have shown up to incite the people and increase the organization’s funding.”

“Finally, what about your statement in our preceding posting that a hospital is a risky place for patients?”

“That’s been documented in our postings and elsewhere.  The potential patient should ask around and search all available literature on hospital and physician safety records and outcomes (2).  My greatest fear is surgical site infections, which contributed to the early demise of my close friend, Stan.”

“I believe that you felt that Mrs. Curmudgeon had been fortunate in that respect.”

“She was, Julie.  Prior to her last surgery, a laparoscopic lung biopsy, I asked the surgeon if he had ordered a prophylactic antibiotic.  He said, ‘No, not for such a straightforward procedure.’  The doc was a crusty surgeon of the old school, so I didn’t press the matter further.  Later, however, I noticed the antibiotic on the hospital bill.  The lesson, of course, is that the patient should be accompanied by a friend or relative.  In our case, it was helpful to have had a little knowledge and to have known the surgeon.  In all cases, the patient should try to make her hospital stay as short as possible.”

“So what’s the bottom line on risk and fear, Curmudge?”

“Use your head.  Study, learn, ask around, but don’t be swayed by the crowd. Keep your perception gap as small as possible.  And look to the right first before crossing a street in Great Britain.”

Kaizen Curmudgeon

 

(1)  Ropeik, David  How Risky Is It, Really?  (2010, McGraw-Hill)

(2)  Suggested resources: The Wisconsin Collaborative for Healthcare Quality, www.wchq.org.  The Leapfrog Group, www.leapfroggroup.org, and www.hospitalsafetyscore.org.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      

Risks and Fears--Introduction

“Julie, in one of my earlier lives…”

“…You mean, Curmudge, before the turn of the century?”

“…I worked with a group whose task was to allay concerns of the populace about trace organic chemicals in a large river in the West.  As the lab guy, I explained that increasingly sensitive test methods revealed chemicals at parts-per-trillion or (even smaller) quadrillion levels that had been there all along.”

“And did the people buy your explanation?”

“Not entirely.  I believed then that the reason was simply their lack of understanding of the facts.  I was wrong.  The people were fearful, and that’s what we are going to discuss today.”

“I don’t get it, Curmudge.  A fact-based explanation should have done it for the apprehensions of most people.  What went wrong?”

“My employer sent the wrong person.  They sent a chemist, but they should have sent a psychologist.  So now, almost 20 years too late, we’re going to explore the psychology of risk and fear.  Our main resource is a book by David Ropeik (1), and fortunately for us, it’s written in easy-to-handle language.”

“So what, may I ask, does this have to do with leadership and health care?”

“Being a patient in a hospital is a risky experience, Julie, and organizational change evokes a degree of fear in the workplace.  Furthermore, people make unhealthful decisions based on fear and misperceptions.  So don’t leave until the fat lady sings, fictional femme, and we’ll both learn something.”

“Okay, Old Guy.  I’m with you.  Are we going somewhere?”

“We’re going on a hike high in the mountains of Glacier National Park.  You are hiking the trail a few yards ahead of me because I paused to photograph a flower.  As you walk around a bend in the trail, there—a few yards to the right—is a grizzly bear eating berries.  What do you do?”

“I jump, and my heart seemingly ‘leaps into my mouth.’  I hit the ground running back down the trail screaming ‘BEAR’ and looking frantically for a tree to climb.  (There aren’t any; we are above the timberline.)  But what happens to you?”

“You survive because you can run faster than I can.  I survive, too, because the bear is more interested in berries than people.”

“Obviously, our little vignette pertains to fear, and you are going to tell us about it, right?  Hopefully in a semi-nontechnical manner.”

“Right, Julie.  There’s not room to write a book in a blog.  Your first sight of the bear triggered your risk response starting in the brain’s thalamus and—in milliseconds—moving to the part of the brain called the amygdala.  Somehow, the amygdala recognized the signal as indicating danger and told you to jump.  That’s the flight or fight response.  No thinking was involved; you were on autopilot.”

“Hey, Curmudge, I learned that the amygdala was an early arrival in the evolution of the brain.  Our cave man forefathers had an amygdala that told them to be fearful of wild beasts.  If they hadn’t had that, they wouldn’t have been anybody’s forefathers.  Oh, and by the way, the amygdala also stores one’s implicit memory, the memory that we can’t consciously recall.  That’s how I knew that grizzly bears are dangerous without taking time to remember reading about them.”

“Next, the thinking part of your brain, the cerebral cortex, got involved and told you to run back down the trail, shout a warning to me, and look for a tree to climb.  So you see that the bear sighting initiated a lot of activity in your brain in this sequence, fear first and think second.  But sometimes that cognitive activity is a very close second, like your shouting ’bear.’  That was an example of bounded rationality in which you used mental shortcuts (heuristics) as the bases for your almost-instantaneous shout.  Another example of quick mental shortcuts is deciding whether to stop or proceed when a traffic light turns yellow.”

“An influence on your decision is called framing, or how facts are presented.  In the yellow light example, your decision will be influenced by there being a police car next to you or someone tailgating you who might not agree with your decision to stop.  And then there‘s loss aversion.  The cost and inconvenience of being rear-ended may outweigh the cost of paying the fine for running the traffic light.”

“You are really getting into this risk stuff, Julie.  Let’s talk next about why some threats seem scarier than others, which Ropeik calls fear factors or risk perception factors.  They make our fears go up or down and cause us to be more or less afraid.  The difference between the actual risk and the perceived risk is the perception gap.  The author presented a substantial list of risk perception factors, most of which are self-explanatory.  Here are a lot of them: trust, risk vs. benefit, control, choice, natural or man-made, causes pain and suffering, uncertainty, new or familiar, risks to children, and fairness.  And of course, can it happen to me or did it happen to someone I know?”

“Curmudge, I fear that my brain is at risk of exploding if it has to absorb any more information today.  Let’s take a week-long coffee break and return to Risks and Fears later.”

Kaizen Curmudgeon                 

(1) Ropeik, David  How Risky Is It, Really?  (2010, McGraw-Hill)