Thinking fast and slow…as a GP.

A bereaved, depressed elderly patient comes in.

It’s automatic. My training and cognitive algorithm kicks in.

History, risk assess, maybe medication if really struggling, signposting, possible referral.

But then before I start, I stop. She’s crying. I stay silent for 2 minutes. When she’s ready we talk. I hold space. She reaches out and I hold her hand. 

She didn’t need anything else other than being heard at that time.

A patient with chronic, unexplained pain arrives later.

I think of differentials, investigations, referrals, treatments.

But then I see she’s overwhelmed. Speaking quickly. I take a deep, calm breath and she does the same. I listen. She slows down and by the end she feels more confident in the next steps.

A son brings his elderly mother in to see me.

Frailty. Suspected cancer. Likely dementia.

I could send her to 6 different urgent care pathways. 

But instead I start with:

“You are doing a wonderful job. And you are so lucky to have each other.”

Then the discussion about what is important to both people comes out. No investigations. Just support. They leave calmer and more in control.

Thinking fast is automatic. It’s ‘safe’. It’s efficient. 

It’s built in muscle memory from years spent on busy wards, A&E departments and GP surgery rooms following guideline after guideline to get through the day.

But unless you are in an emergency situation, humans don’t fit into neat fast protocols.

Complexity can’t be cured with quick thinking.

Slow thinking is deliberate. It’s human.

It starts with intent to connect. To sit quietly. To get out of your head and start listening with your heart.

To build trust first because you know that will be worth 20 blood tests and X-rays in the long run.

Slowing down doesn’t mean wasting time. It means spending time well.

In my cognitive therapy work I see the pitfalls of fast vs slow too.

Fast thinking leads to assumptions.

Pain = damage.

Depression = medication.

Fatigue = something must be missed.

But as doctors if we model slower thinking, we give patients permission to examine their own assumptions and explore deeper answers.

If we start to slow down and ‘feel’ again, we help them do the same.

There is space for both fast and slow in general practice. It’s essential.

But when you sense a patient is lost, scared, in pain or overwhelmed. 

Or maybe if you are feeling the same as their doctor.

Slow down.

Hold space.

Listen.

Feel.

Challenge assumptions.

Because with people.

Slow is always faster in the long run.

What do you think?

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