The speaker, a neuroscientist, shares a personal anecdote about a night when he broke into his own house due to losing his keys and forgetting his passport. This led to a series of unfortunate events, including forgetting his passport at the airport and ending up in the back of a plane, a seat that wouldn't recline. This experience prompted the speaker to reflect on the importance of systems that can prevent or minimize negative outcomes.
The speaker introduces the concept of "pre-mortem", a practice of considering potential negative outcomes and developing strategies to prevent them. He discusses the use of pre-mortem in everyday situations, such as losing items due to poor organization, and in more serious contexts, like medical decision-making.
The speaker emphasizes the importance of considering the potential side effects and the number needed to treat when making medical decisions. He uses the example of statins for high cholesterol and prostate removal for cancer, both of which have high numbers needed to treat and significant side effects.
The speaker concludes by sharing that he installed a combination lock on his door after his experience. He acknowledges that he still has unsorted mail and emails, indicating that organization is a gradual process. He emphasizes the importance of pre-mortem thinking in anticipating potential failures and putting systems in place to minimize damage or prevent negative outcomes.
1. The speaker broke into their own house a few years ago because they didn't have their keys and all the doors and windows were locked.
2. The incident occurred around midnight in the dead of Montreal winter, with the thermometer reading minus 40 degrees.
3. The speaker had been visiting a friend, Jeff, across town and had an early flight to Europe the next morning.
4. Desperate and freezing, the speaker broke a basement window, taped a piece of cardboard over the opening, and called a contractor to fix it.
5. The speaker is a neuroscientist and understands how the brain performs under stress, releasing cortisol that raises heart rate, modulates adrenaline levels, and clouds thinking.
6. The speaker had an early flight to Europe the next morning and needed to get their passport and suitcase.
7. The speaker broke a basement window, crawled through, and taped a piece of cardboard over the opening.
8. The speaker found out they didn't have their passport at the airport check-in counter and had to race home to get it.
9. The speaker's seat was given away to someone else at the airport, and they had to sit in the back of the plane, next to the bathrooms, in a seat that wouldn't recline.
10. The speaker had a lot of time to think during the eight-hour flight with no sleep.
11. The speaker started wondering if there are systems that can be put into place to prevent bad things from happening or minimize the likelihood.
12. The speaker had dinner with their colleague, Danny Kahneman, who shared about a concept called prospective hindsight, also known as the pre-mortem.
13. The pre-mortem involves looking ahead and trying to figure out all the things that could go wrong, and then figuring out what can be done to prevent those things from happening or minimize the damage.
14. The speaker suggests designating a place at home for things that are easily lost, like keys, passports, and reading glasses.
15. For travel, the speaker suggests taking a cell phone picture of credit cards, driver's license, passport, and mailing it to oneself so it's in the cloud.
16. The speaker mentions a pre-mortem practice of recognizing that under stress, cortisol is released which causes cloudy thinking, and systems should be put in place.
17. The speaker discusses a medical condition and mentions a statistic called the Number Needed to Treat (NNT), which is the number of people that need to take a drug or undergo a surgery before one person is helped.
18. The speaker mentions that for the most widely prescribed statin, the NNT is 300, meaning 300 people have to take the drug for a year before one heart attack, stroke, or other adverse event is prevented.
19. The speaker mentions that the side effects occur in five percent of the patients for this particular drug, including debilitating muscle and joint pain, gastrointestinal distress.
20. The speaker mentions that for the most widely performed surgery on men over the age of 50, the number needed to treat is 49, meaning 49 surgeries are done for every one person who's helped. The side effects in that case occur in 50 percent of the patients, including impotence, erectile dysfunction, urinary incontinence, rectal tearing, fecal incontinence.
21. The speaker mentions that they had their contractor install a combination lock next to the door with a key to the front door in it, an easy to remember combination, after the incident in Montreal.
22. The speaker admits that they still have piles of mail and emails that they haven't gone through.
23. The speaker sees organization as a gradual process and they are working on it.