Judgements and decisions are made by us on daily basis. Medical leaders make judgements in the clinical practice, positions of authority and in service management. How is our decision making influenced? 
 
Daniel Kahneman, in his book, ‘Thinking Fast and Slow’ (a Penguin publications), discusses two different systems of thinking. System 1 which does the fast thinking, and System 2 which does the effortful and slow thinking. 
 
System 1 operates automatically and quickly, with little or no effort and no sense of voluntary control. This is our flight response in the face of danger. System 1 thinking is based on our impressions and feelings, which lead to our beliefs and choices. 
 
System 2, on the other hand, is slow, deliberate mental activity which constructs thoughts and complex pattern of ideas. This type of thinking is used in problem solving and constructing reasoning. 
 
We all have conscious and unconscious biases; these can influence our decision making. System 1 thinking is said to be the source of errors and biases. So, what can we do about our biases, and improve our judgements and decisions? Although it is not easy, there are certain things that we can practice upon to minimise and remove bias from our thinking. 
 
First, recognise the signs, always be mindful of your own (and other’s) conscious or unconscious biases. 
 
Seek help from your System 2, by slowing down your thinking and using reason and rationality. However, this is easier said than done. The voices of our intuition and our survival instincts are much louder than the voice of reason. One suggested method of overcoming this is - by being an observer more often. We can begin to be aware of some of the pitfalls by being less cognitively busy, and spending time being a bystander to be more receptive to information. As some of these important levels of information may be missed when we are deeply involved in the action. 
 
Taking time out to reflect on your own actions and decisions can influence your own biases, and help to amplify the relatively faint voice of reason. 
 
To conclude, System 1 thinking is our natural survival response which can lead to instinctive and impulsive actions. Slowing down to System 2 thinking, using reason, reflection and observation are some of the methods to overcome our biases and support our decision making. 
 
 

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