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Scottish National Users' Group (SNUG) PodcastAuthor: snughealth
Supporting Scotland's Primary Care GP software users: welcome to the Scottish National Users Group (SNUG). Language: en Genres: Health & Fitness, Medicine, Technology Contact email: Get it Feed URL: Get it iTunes ID: Get it |
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Making decisions: a hat, a haircut or a tattoo?
Episode 77
Monday, 17 August, 2026
Jonathan Underhill, pharmacist and long-standing advocate of evidence-informed and shared decision-making, discusses why applying clinical guidelines mechanically does not always produce the best outcome for an individual patient. Drawing on his work at the National Prescribing Centre and NICE, he explains how population-level evidence needs to be balanced against comorbidity, adverse effects, diminishing returns from additional medicines, and, importantly, the patient’s own values and preferences. He describes the “three-talk” model of choice, options and decision. We get into how clinicians actually make decisions, with heavy reliance on rapid pattern recognition and mental “mindlines”, why good practice requires knowing when to switch from intuitive “system one” thinking to slower, more deliberate checking, and ponder whether prescribing decisions are analogous to whether the patient is getting a hat, a haircut or a tattoo, and how more time is usually needed to make a good decision. We learn about information mastery and the usefulness equation, which states that information is most useful when it is relevant and valid while requiring relatively little work to obtain, and consider how AI could dramatically reduce the effort involved in finding clinical information. While there is considerable potential for AI to compensate for clinicians’ limited ability to remember an ever-expanding evidence base, particularly when it is grounded in trusted sources such as NICE or Cochrane, clinicians must continue to question validity, think critically and retain the human role in complex decisions and reassuring anxious patients. We also discover a shared enthusiasm for Bruce Springsteen, including Jonathan’s memories of seeing him live 44 times and some of his most memorable concerts. System 1 and System 2 Thinking The Decision Lab. Muir Gray: Population based and personalised care—two sides of the same coin Evidence based guidelines or collectively constructed “mindlines?” BMJ Paper by Gabbay and le May Explainer on Information Mastery PrescQIPP Talking Meds podcast Carronbank Medical Search Engine Brucebase wiki
