Best/Worst Analysis: A Mental Model for Risk Aversion

Dr. Ben Carson, who was part of the Trump Cabinet, established his reputation as a groundbreaking neurosurgeon in the Johns Hopkins medical system. In Take the Risk: Learning to Identify, Choose, and Live with Acceptable Risk (2009,) Carson reflects on fear, hesitation, and facing the risks he took for himself and his patients:

You don’t go into a field that requires cracking people’s heads open or operating on something as delicate as the spinal cord unless you are comfortable with taking risks.

Every day I make critical, split-second decisions that affect the longevity and the quality of other people’s lives. Taking such risks gives me pause. It forces me to think about my own life and the risks I face. Those experiences enable me to move forward and avoid becoming paralyzed by fear. As a result, I probably do a lot of things that more cautious people would never attempt.

Next time you’re fretting over how to proceed in a dicey situation, Carson suggests using a mental model he calls the ‘Best/Worst Risk Analysis.’

Putting on the optimist/pessimist hats and imagining the best-case/worst-case scenarios, ask yourself these questions:

• What’s the best thing that can happen if I do it?
• What’s the worst thing that can happen if I do it?
• What’s the best thing that can happen if I don’t do it?
• What’s the worst that can happen if I don’t do it?

It’s a variation of Ben Franklin’s humble “pro et contra” (“for and against”) system for decision-making.

Research has shown that this Best/Worst Risk Analysis mental model promotes shared decision-making. In the surgical environment, it helps surgeons organize challenging treatment dialogs to support patients and their families. This mental model helps surgeons communicate by turning the refocus of decision-making conversations from a surgical problem’s uncertainties to discussing treatment alternatives and potential outcomes.