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Snap Judgment: When to Trust Your Instincts, When to Ignore Them, and How to Avoid Making Big Mistakes with Your Money by David E. Adler

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25. How Patients Think Irrationally

Richard S. felt short of breath, couldn’t stop sweating, and had a strange headache. The 40-something truck driver was aware of the warning signs of a heart attack—he had suffered from several, so he went to the nearest emergency room, at Foote Hospital in Jackson, Michigan. Richard was all too experienced with the health system. In addition to his heart attacks, he had uncontrolled hypertension and was recovering from a stroke.

The emergency medicine attending at the time was Dr. Kirsten Engel, who was also working on a research fellowship. Here are her notes about “Richard” from that night (I have changed the patient’s identifying details):

“The patient before me was a 40-year-old man with a history of poorly ...

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