Medical malpractice, mistake prevention, and compensation.

Clinicians' fear of malpractice litigation is the most significant obstacle to the open reporting of medical mistakes. Without open reporting of medical mistakes, however, root cause analysis of mistakes cannot be done, thus undermining efforts to implement safeguards to minimize the occurrence of future mistakes. Efforts to prevent medical mistakes, therefore, must first directly address clinicians' fear of malpractice litigation. In this paper, we explore the relationship between the current malpractice system and clinicians' fear of litigation. Ultimately, we argue that both the prevention of medical mistakes and the goals of malpractice litigation itself will be better served if substantial malpractice reform is undertaken.     

Deliberate commission of category mistake. Crombie vs. Ryle

Crombie's acceptance of the deliberate commission of a category mistake in his defense of the meaningfulness of theological statements raises a pointed challenge to the philosophy of Ryle which seems not to have been specifically addressed in subsequent literature. We review the analysis which leads Crombie into it, including concepts of anomaly, deficiency, affinity, and inadequate notion, noting basic differences in method and attitude from Ryle. We express our own agreements and disagreements in keeping with an overall concern for the preservation of rationality in this sphere of language, finding acceptable distinct contributions to that end from both.     

Maximizing the response rate in surveys may be a mistake

A random postal sample of 400 Australians was carried out with the assistance of two conventional response-rate maximization techniques: a preliminary letter and a second mailing of the questionnaire aimed at non-respondents to the first questionnaire. The response-rate enhancement techniques appeared to have doubled the response rate from a usual 25% for a one-wave mailing to 47% on the present occasion. The present data, however, showed severe effects of acquiescent response bias (‘saying yes to anything’), thus severely damaging the meaningfulness of the results. It is concluded that the use of response-rate enhancement techniques is not only unnecessary but is also in fact counter-productive.     

Darwin's mistake: explaining the discontinuity between human and nonhuman minds

Over the last quarter century, the dominant tendency in comparative cognitive psychology has been to emphasize the similarities between human and nonhuman minds and to downplay the differences as "one of degree and not of kind" (Darwin 1871). In the present target article, we argue that Darwin was mistaken: the profound biological continuity between human and nonhuman animals masks an equally profound discontinuity between human and nonhuman minds. To wit, there is a significant discontinuity in the degree to which human and nonhuman animals are able to approximate the higher-order, systematic, relational capabilities of a physical symbol system (PSS) (Newell 1980). We show that this symbolic-relational discontinuity pervades nearly every domain of cognition and runs much deeper than even the spectacular scaffolding provided by language or culture alone can explain. We propose a representational-level specification as to where human and nonhuman animals' abilities to approximate a PSS are similar and where they differ. We conclude by suggesting that recent symbolic-connectionist models of cognition shed new light on the mechanisms that underlie the gap between human and nonhuman minds.     

Do the wrong thing: How toddlers tell a joke from a mistake

We investigated whether 19–36-month-olds (1) differentiate mistakes from jokes, and (2) understand humorous intentions. The experimenter demonstrated unambiguous jokes accompanied by laughter, unambiguous mistakes accompanied by the experimenter saying, “Woops!”, and ambiguous actions that could either be a mistake or a joke, accompanied by either laughter or, “Woops!” Toddlers were asked to try. Nineteen- to 36-month-olds differentiated jokes and mistakes by copying unambiguous jokes and correcting unambiguous mistakes. Only 25–36-month-olds differentiated mistakes and humorous intentions by copying ambiguous actions marked by laughter, and correcting those marked by, “Woops!” Understanding humorous intentions precedes understanding intentions behind pretense, lying, and false beliefs, thus may be a first step in understanding that others can intend to do the wrong thing.     

Ferenczi's fatal illness in historical context

In August 1932, Ferenczi was already manifesting symptoms of his fatal illness, pernicious anemia. This was diagnosed between September 20 and October 2 of that year, less than a month after the Twelfth International Psychoanalytic Congress in Wiesbaden. Despite seemingly successful treatment with injectable liver extract, he underwent an acute psychotic episode in March 1933, triggered by the neurological symptoms of his illness. These facts substantiate the subsequent claim of Freud and Jones that Ferenczi suffered from paranoia near the end of his life, but they do not support the commonly-held view that the writings and experiments in psychoanalytic technique of his last five years were symptomatic of a progressive mental illness.     

Brain mechanisms in fatal cardiac arrhythmia

Intravenous injection of histamine to rabbits was used as a prototype in an investigation of the mechanism of sudden death due to anaphylaxis and other causes. The “dive” reflex, bradycardia due to activation of the ophthalmic branch of the fifth cranial nerve, was induced in thirty-seven of the animals while they inhaled a very small amount of cigarette smoke. Associated with the resulting bradycadia were lowered blood pH and increased serum content of lactic acid and potassium and increased peripheral arterial constriction with elevation of diastolic blood pressure. Intravenous injection of 1 ml of histamine in the presence of the dive reflex induced potentially fatal ventricular arrhythmia, but no cardiac disturbance when administered while the dive reflex was inactive, thereby strongly suggesting that sudden death in anaphylaxis may involve an overzealous response to a normally protective neural reflex.     

Brain mechanisms in fatal cardiac arrhythmia.

Intravenous injection of histamine to rabbits was used as a prototype in an investigation of the mechanism of sudden death due to anaphylaxis and other causes. The "dive" reflex, bradycardia due to activation of the ophthalmic branch of the fifth cranial nerve, was induced in thirty-seven of the animals while they inhaled a very small amount of cigarette smoke. Associated with the resulting bradycardia were lowered blood pH and increased serum content of lactic acid and potassium and increased peripheral arterial constriction with elevation of diastolic blood pressure. Intravenous injection of 1 ml of histamine in the presence of the dive reflex induced potentially fatal ventricular arrhythmia, but no cardiac disturbance when administered while the dive reflex was inactive, thereby strongly suggesting that sudden death in anaphylaxis may involve an overzealous response to a normally protective neural reflex.