Ep. 51 The Expert vs. the Algorithm: Gary Klein on Decision-Making in Healthcare

Gary Klein, PhD

Doctors are increasingly asked to follow decision rules, guidelines, and “evidence-based” algorithms.  Is that the right approach to take care of patients?  Are cognitive errors over-emphasized in healthcare?

Our guest on this episode is  Gary Klein, one of the most important figures in cognitive psychology in the world.  His pioneering work in the field of naturalistic decision-making has become a major challenge to the established schools of thought on how experts make good decisions.

He is a leader of a growing research community focused on understanding how human beings acquire and apply knowledge to complex situations under uncertainty.  He has developed novel explanatory models and training methods for decision-making that are widely recognized as ground-breaking.  He is the author of numerous books, including the best-sellers Streetlights and Shadows: Searching for the Keys in Adaptive Decision-Making and Seeing What Others Don’t: The Remarkable Ways We Gain Insight.   He is notorious for having gained the respect and admiration of his intellectual opponent, Nobel Prize winner Daniel Kahneman, with whom he co-authored a widely read paper contrasting their somewhat divergent views.


Gary Klein, PhD: Website and Twitter.

ShadowBox training website.


Gary Klein.  Streetlights and Shadows: Searching for the Keys in Adaptive Decision-Making. A Bradford Book. 2001 (Amazon link)

Gary Klein. Seeing What Others Don’t: The Remarkable Ways We Gain InsightPublic Affairs. 2015.  (Amazon Link)

Daniel Kahneman and Gary Klein.  Conditions for Intuitive Expertise: A Failure to Disagree.  American Psychologist.  Sep 2009 (open access).

Klein ED, Woods DD, Klein G, and Perry SJ.  Can We Trust Best Practices: Six Cognitive Challenges of Evidence-Based Approaches.  Journal of Cognitive Engineering and Decision-Making. 2016 (open access)


Ep. 30 Beyond EBM: Case-Based Reasoning and the Integration of Clinical Knowledge


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1 Comment

  1. Rafael Cruz, MD on 05/07/2019 at 1:46 PM

    Algorithmic medicine, I have thought for a long time, contributes to what I suggest is “the dumbing down of medicine” for the purpose of cost control and profit. The deductive reasoning method or differential diagnosis method taught to us during training is the core of our mental muscle building process. Traditional grand rounds, where the experts would share their opinions, not only contributed to my own expertise and intuitive abilities acquired by exposure to these experts but also ingrained the culture that was once academic medicine. But, grand rounds have been replaced by and large by computer based CME. Nurse Practitioners are replacing physicians which is justified by algorithms and supported by evidence based (bs). I call this, “monkey medicine.” This podcast supports my discontent with how medicine is practiced today. Thank you!

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