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Cognitive Theory: Fast and Slow

Consider some examples of actions and decisions that we have to make.  Do they make use of the fast or slow process—System 1 or System 2?

Instructions: For each action or decision, think about the first thing that comes to mind. Then hover over the box.

How do you put on your shoes in the morning?

Something you don’t think about?

This is a System 1, automatic or reflexive process.  After doing this innumerable times since childhood, you don’t need to think twice how to put on your shoes (“put out your shoes where you can see them, slip the toes of one foot into the opening of the corresponding shoe while maintaining balance, slide your foot into the shoe, shift your balance, repeat with the opposite foot with the opposite shoe…”).

Which antibiotic should we administer this patient being admitted with fevers, flank pain, and dysuria?

Ceftriaxone!

You’ve probably gone down this algorithm multiple times and the go-to empiric antibiotic is Ceftriaxone. If that’s the case, there was little uncertainty that the diagnosis is unnuanced pyelonephritis. So, your cognitive faculties took the most expedient, cost-effective route by employing System 1 to get to the answer.

This may not have been an easy decision the first couple times you had to treat pyelonephritis (System 2 thought), but by now, it’s become reflexive (System 1).  But through analytic thought plus repetition, System 1 can be trained to recognize the pattern of symptoms for pyelonephritis and associate the treatment with IV Ceftriaxone.

Which antibiotic should we administer this patient being admitted with fevers, flank pain, and dysuria with a history of ESBL UTI and allergies to beta-lactams and aminoglycosides?

Let me think about this one!

You might have to put a little more thought into this one or tell yourself you need more data or knowledge.  If that’s the case, that’s because uncertainty has been recognized, and therefore System 1 cannot be employed to answer this question.

Therefore, System 2 is engaged to seek out the answer.

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