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Reddit was about to become the preeminent place for "real 'expert'" AMAs that were extremely useful and enlightening.

AMAs among common folk focus on dishing on what sex, disease, or jobs are really like. The celebrity versions borrow the same idea, but they serve up inside information on celebrity itself (generally speaking) or politics itself. 

The AMA is supposed to expose the mechanism. The AMA is about exposing the "inside conversations." The AMA is like the crowdsourced version of those moments when Kevin Spacey turns to the camera in House of Cards and breaks things down. 

Last month, the A.M.A.’s leaders admitted to serious missteps and proposed a three-year plan to “dismantle structural racism” within the organization and in medicine. The announcement on Tuesday did not mention the status of the investigation at JAMA. The journal declined further comment.

“This is a real moment for JAMA and the A.M.A. to recreate themselves from a founding history that was based in segregation and racism to one that is now based on racial equity,” said Dr. Stella Safo, a Black primary care physicia

Dr. Safo and her colleagues started a petition, now signed by more than 9,000 people, that had called on JAMA to restructure its staff and hold a series of town hall conversations about racism in medicine. “I think that this is a step in the right direction,” she said of the announcement.

“In the entire history of all the JAMA network journals, there’s only been one non-white editor,” noted Dr. Raymond Givens, a cardiologist at Columbia University in New York. I

It can occur when a physician refuses to consider alternative diagnoses once an initial diagnosis has been established, despite contradicting data, such as lab results. This bias leads physicians to see what they want to see

Anchoring bias is closely related to confirmation bias and comes into play when interpreting evidence. It refers to physicians’ practices of prioritizing information and data that support their initial impressions, even when first impressions are wrong

When physicians move from deliberation to action, they are sometimes swayed by emotional reactions rather than rational deliberation about risks and benefits. This is called the affect heuristic, and, while heuristics can often serve as efficient approaches to problem solving, they can sometimes lead to bias

Further down the treatment pathway, outcomes bias can come into play. This bias refers to the practice of believing that good or bad results are always attributable to prior decisions, even when there is no valid reason to do so

The dual-process theory, a cognitive model of reasoning, can be particularly relevant in matters of clinical decision making

This theory is based on the argument that we use 2 different cognitive systems, intuitive and analytical, when reasoning. The former is quick and uses information that is readily available; the latter is slower and more deliberate.

Consideration should be given to the difficulty physicians face in employing analytical thinking exclusively. Beyond constraints of time, information, and resources, many physicians are also likely to be sleep deprived, work in an environment full of distractions, and be required to respond quickly while managing heavy cognitive loads

Simply increasing physicians’ familiarity with the many types of cognitive biases—and how to avoid them—may be one of the best strategies to decrease bias-related errors

The same review suggests that cognitive forcing strategies may also have some success in improving diagnostic outcomes

Afterwards, the resident physicians were debriefed on both case-specific details and on cognitive forcing strategies, interviewed, and asked to complete a written survey. The results suggested that resident physicians further along in their training (ie, postgraduate year three) gained more awareness of cognitive strategies than resident physicians in earlier years of training, suggesting that this tool could be more useful after a certain level of training has been completed

A 2013 study examined the effect of a 3-part, 1-year curriculum on recognition and knowledge of cognitive biases and debiasing strategies in second-year residents

Cognitive biases in clinical practice have a significant impact on care, often in negative ways. They sometimes manifest as physicians seeing what they want to see rather than what is actually there. Or they come into play when physicians make snap decisions and then prioritize evidence that supports their conclusions, as opposed to drawing conclusions from evidence

Fortunately, cognitive psychology provides insight into how to prevent biases. Guided reflection and cognitive forcing strategies deflect bias through close examination of our own thinking processes.

During medical education and consistently thereafter, we must provide physicians with a full appreciation of the cost of biases and the potential benefits of combatting them.