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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.