In 1985, he was accepted as a medical resident at the Stanford University hospital. At Stanford he began, haltingly, to voice his professional skepticism. One night during his second year, he was manning the intensive care unit and was assigned to keep a young man alive long enough to harvest his organs. (The American euphemism—“harvesting”—sounded strange to his ears. In Canada they called it “organ retrieval.”) His brain-dead patient was a twenty-one-year-old who had wrapped his motorcycle around a tree.
It was the first time Redelmeier had been confronted with the dying body of a person younger than himself, and it bothered him, in a way that the deaths of older people he had witnessed had not. “It was such a loss of so many life years,” he said. “It was such a preventable case. And the guy hadn’t been wearing a helmet.” Redelmeier was newly struck by the inability of human beings to judge risks, even when their misjudgment might kill them. When making judgments, people obviously could use help—say, by requiring all motorcyclists to wear helmets. Later Redelmeier said as much to one of his fellow students, an American. What is it with you freedom-loving Americans? he asked. Live free or die. I don’t get it. I say, “Regulate me gently. I’d rather live.” His fellow student replied, Not only do a lot of Americans not share your view; other physicians don’t share your view. Redelmeier’s fellow student told him about Stanford’s famous head of cardiac surgery, Norm Shumway, who had actively lobbied against the creation of a law that would require motorcyclists to wear helmets. “It dropped my jaw,” said Redelmeier. How could a guy so smart be so stupid about that? We’re definitely capable of errors. And human fallibility should be paid attention to.”
At the age of twenty-seven, as he finished his Stanford residency, Redelmeier was creating the beginnings of a worldview that internalized the article by the two Israeli psychologists that he had read as a teenager. Where this worldview would lead he did not know. He still thought it possible that, upon his return to Canada, he might just move back up to northern Labrador, where he had spent one summer during medical school delivering health care to a village of five hundred people. “I didn’t have great memory skills or great dexterity,” he said. “I was afraid I wouldn’t be a great doctor. And if I wasn’t going to be great, I might as well go to serve someplace that was underserved, where I was needed and wanted.” Redelmeier actually still believed that he might wind up practicing medicine in a conventional manner. But then he met Amos Tversky.
* * *
Redelmeier had long made a habit of anticipating his own mental errors and correcting for them. Alive to the fallibility of his memory, he carried a notepad wherever he went and wrote down thoughts and problems as they occurred to him. When awakened late at night by a phone call from the hospital, he always lied and told the fast-talking resident on the other end of the line that they had a bad connection, and so he needed to repeat everything he had just said. “You can’t tell a resident he is speaking too quickly. You blame yourself—and it facilitates not only his thinking but my own.” When a visitor turned up in Redelmeier’s office when he was between rounds, he would set a kitchen timer to make sure he didn’t get lost in conversation and wind up late for his patients. “Redelmeier loses track of time when he is having fun,” said Redelmeier. In advance of any social situation, he went to unusual lengths to correct whatever he imagined might go wrong. When he gave a talk—still a massive challenge for him, with his stammer—he cased the lecture hall and simulated his entire performance.
And so, in the spring of 1988, for Redelmeier it felt perfectly normal, two days before his first lunch with Amos Tversky, to walk through the Stanford Faculty Club dining room where they were scheduled to meet. On the day of the lunch, he moved his hospital tour of patients from 6:30 in the morning to 4:30, to reduce the risk that anyone’s medical problems would interfere with his meeting. He didn’t eat breakfast usually, but on this day he did, so that he wouldn’t be distracted by hunger during lunch. As was also his habit, he jotted down in advance little notes—potential topics of discussion—“for fear of blanking.” Not that he intended to say much. Hal Sox, Redelmeier’s superior at Stanford, who would be joining them, had told Redelmeier, “Don’t talk. Don’t say anything. Don’t interrupt. Just sit and listen.” Meeting with Amos Tversky, Hal Sox, said, was “like brainstorming with Albert Einstein. He is one for the ages—there won’t ever be anyone else like him.”
Hal Sox happened to have coauthored the first article Amos ever wrote about medicine. Their paper had sprung from a question Amos had put to Sox: How did a tendency people exhibited when faced with financial gambles play itself out in the minds of doctors and patients? Specifically, given a choice between a sure gain and a bet with the same expected value (say, $100 for sure or a 50-50 shot at winning $200), Amos had explained to Hal Sox, people tended to take the sure thing. A bird in the hand. But, given the choice between a sure loss of $100 and a 50-50 shot of losing $200, they took the risk. With Amos’s help, Sox and two other medical researchers designed experiments to show how differently both doctors and patients made choices when those choices were framed in terms of losses rather than gains.
Lung cancer proved to be a handy example. Lung cancer doctors and patients in the early 1980s faced two unequally unpleasant options: surgery or radiation. Surgery was more likely to extend your life, but, unlike radiation, it came with the small risk of instant death. When you told people that they had a 90 percent chance of surviving surgery, 82 percent of patients opted for surgery. But when you told them that they had a 10 percent chance of dying from the surgery—which was of course just a different way of putting the same odds—only 54 percent chose the surgery. People facing a life-and-death decision responded not to the odds but to the way the odds were described to them. And not just patients; doctors did it, too. Working with Amos, Sox said, had altered his view of his own profession. “The cognitive aspects are not at all understood in medicine,” he said. Among other things, he could not help but wonder how many surgeons, consciously or unconsciously, had told some patient that he had a 90 percent chance of surviving a surgery, rather than a 10 percent of dying from it, simply because it was in his interest to perform the surgery.