Automaticity

Systems of thinking relates our approach to risk and decision making (Kahneman 2011).  It is argued that there are two systems of thinking that people are engaged in through the course of their daily activities.  

System 1 – automatic, intuitive, effortless, nonanalytic

System 2 – effortful, analytic, creative, deliberative

Automatic thought processes come into play when we are driving a familiar route.  We feel like we almost got there on automatic pilot.  Effortful thought processes come into play when we drive to a new destination and there is a choice of routes, some of which may be better at different times of day and may depend on traffic and so on.  Choosing the best route requires deliberation and effort. 

In the context of healthcare, system 1 and system 2 have been viewed as being based on tacit and explicit knowledge respectively.  Tacit knowledge are the skills, values, and experiences learned during observation and practice that are not explicitly stated or known to practitioners, whereas explicit knowledge is the conscious application of defined rules and objectively verifiable data to the patient’s problem, such as evidence-based guidelines.

According to automaticity theorists, individuals move from system 2 (requiring attention, effortful) to system 1 (automatic, intuitive) as they gain experience. An experienced nurse taking a patient’s blood pressure simply and effortlessly puts the cuff around the arm and takes the blood pressure while talking with the patient simultaneously, a task that would have required much more of her attention when the task was new. As we become experienced in an activity, whether it is a physical task such as taking a blood pressure or a mental task such as the diagnosis of a skin rash, the effort that is required to perform that task diminishes over time. The expert simply knows (or thinks they know) what to do and how to do it.

Many errors committed by experienced clinicians can be due to their overreliance on the automatic way of working, and overreliance on the automatic mode is termed as drifting. Surgeons describe the fact that can they make errors during the routine, easy, or boring parts of the procedure where they felt they had drifted off.  Routine cases or times of boredom can lead to people not paying as much attention as they should, they end up by being distracted by their own mind or by others.