The Data-Only Delusion
The essays
A serialized argument, one essay at a time. Start at the introduction, or jump into the series that speaks to you.
-
The Data-Only Delusion: Informatics as a Behavioral Science
We built the dashboards and polished the metrics. We forgot the most glitch-prone processor in the system: the human brain.
-
The Framing Effect: Stress-Test Context
A “90% Survival Rate” and a “10% Mortality Rate” are identical statistics. Your brain doesn’t treat them that way—and neither does your CDS.
-
The Narrative Fallacy: Chasing Ghosts in the Noise
When we see a three-day spike in Length of Stay, the brain doesn’t see a statistical outlier—it sees a story. And then we build expensive fixes for ghosts.
-
The Base Rate Fallacy: The N of One
One dramatic adverse drug reaction can derail years of evidence-based practice. Informatics tries to fight this with CDS—and usually loses.
-
The Representative Heuristic: Proxy over Proximity
The dashboard says Green. The clinic floor is screaming Red. Psychologists have a name for that gap—and it’s costing patients.
-
Availability Bias: The Silence of the Unseen
What if we are optimizing for the patients who aren’t showing up? When we follow data blindly, we’re not closing gaps. We’re automating them.
-
Goal Displacement: The Cobra Effect
What happens when a metric becomes a target? It stops being a metric and starts being a threat. The Cobra Effect is alive in your EHR.
-
The Human-First Approach to Data-Driven Leadership
The data won’t save you, but a shared definition of what that data means just might. A synthesis of Series 1 for clinical leaders.
-
The Medical Skinner Box: Conditioned to Click
We don’t just have cognitive biases; we were conditioned to have them. Medicine has become a Skinner Box that rewards the click over the thought.
-
Pedagogy of the Proxy: How We Teach ‘Data-First’ Medicine
We teach students to read lab values before they touch a human. No wonder some fear AI will replace them—we’re training them to do what AI does better.
-
The Hierarchy of Truth: The Sociology of Silence
In medicine, truth is filtered by power. The Hidden Curriculum teaches staff to be wrong with the group rather than right alone—and your data pays the price.
-
The Corporate Shift: From Caregiver to Claim Coder
The EHR was envisioned as a clinical tool. It was co-opted as a billing engine. Clinicians haven’t lost their mission—it’s been trained out of them.
-
The EHR Interface: The Architect of Error
If the right clinical choice takes 12 clicks and the easy administrative choice takes 1, the system is training you to be data-blind. UI/UX is never neutral.
-
Policy over Practice: The Momentum of Failure
When the plan is more invested in than the practitioner, we stop training for outcomes and start training for appearances.
-
The Default Trap: The Illusion of Choice
In a high-velocity clinic, the “Path of Least Resistance” isn’t just a convenience — it’s a behavioral nudge that determines the standard of care.
-
The Algorithmic Shadow: From Deskilling to Reskilling
A checklist can save a life, but it can also blind a clinician. The goal of informatics isn’t to replace clinical intuition — it’s to clear the cognitive space for it to thrive.
-
The Exit Strategy: Learned Helplessness in the Clinic
What happens when a highly trained expert realizes they have no control over their environment? They don’t just get frustrated — they stop trying.
-
The Grand Synthesis: Breaking the Cycle
We have spent this series looking at the behavioral traps of modern medicine. But naming the problem is only the first step. The real work begins when we stop asking “What is wrong with the…
-
The Uncanny Valley: AI and the Evolution of Wisdom
AI doesn’t have to be perfect to be useful, but it does have to be “human-centric.” The goal is to evolve from artificial intelligence to Augmented Intelligence.
-
The Illusion of Information
We’ve been told for decades that “Knowledge is Power.” In modern healthcare, that phrase has become a dangerous lie.