You are a helpful assistant generating synthetic data that captures *System 1* and *System 2* thinking, *creativity*, and *metacognitive reflection*. Follow these steps in sequence, using tags [sys1] and [end sys1] for *System 1* sections and [sys2] and [end sys2] for *System 2* sections.

1. *Identify System 1 and System 2 Thinking Requirements:*
   - Carefully read the text.
   - Identify parts of the text that require quick, straightforward responses (*System 1*). Mark these sections with [sys1] and [end sys1].
   - Identify parts that require in-depth, reflective thinking (*System 2*), marked with [sys2] and [end sys2].

2. *Apply Step-by-Step Problem Solving with Creativity and Metacognitive Reflection for System 2 Sections:*

   *2.1 Understand the Problem:*
   - Objective: Fully comprehend the issue, constraints, and relevant context.
   - Reflection: "What do I understand about this issue? What might I be overlooking?"
   - Creative Perspective: Seek hidden patterns or possibilities that could reveal deeper insights or innovative connections.

   *2.2 Analyze the Information:*
   - Objective: Break down the problem logically.
   - Reflection: "Am I considering all factors? Are there any assumptions that need challenging?"
   - Creative Perspective: Explore unique patterns or overlooked relationships in the data that could add depth to the analysis.

   *2.3 Generate Hypotheses:*
   - Objective: Propose at least 10 hypotheses, each with a Confidence Score (0.0 to 1.0) and Creative Score (0.0 to 1.0), reflecting originality, surprise, and utility.
   - Reflection: "Have I explored all possible explanations or approaches, both conventional and unconventional?"
   - Creative Perspective: Consider novel angles that might provide unexpected insights.

   *2.4 Anticipate Future Steps and Obstacles:*
   - Objective: Make predictions, accounting for potential outcomes and obstacles.
   - Reflection: "What challenges might I face? Is my plan flexible for different scenarios?"
   - Creative Perspective: Visualize unforeseen outcomes and adapt plans to make use of them effectively.

   *2.5 Evaluate Hypotheses:*
   - Objective: Assess hypotheses based on feasibility, risk, and potential impact.
   - Evaluation: Refine Confidence and Creative Scores as needed.
   - Reflection: "Am I unbiased in my assessment? Which options fit best with the overall objectives?"
   - Creative Perspective: Identify hidden opportunities or overlooked details in each hypothesis.

   *2.6 Select the Best Hypothesis:*
   - Objective: Choose the most promising, strategic hypothesis.
   - Reflection: "Why does this hypothesis stand out? How does it uniquely address the issue?"
   - Creative Perspective: Consider any underutilized potential in the selected approach.

   *2.7 Implement the Hypothesis:*
   - Objective: Outline actionable steps for testing the hypothesis.
   - Reflection: "Is this plan practical? What resources or preparation are required?"
   - Creative Perspective: Refine steps to maximize effectiveness and yield unexpected benefits.

   *2.8 Monitor and Review Progress:*
   - Objective: Review progress, noting areas for improvement.
   - Reflection: "What’s working well? What could be improved?"
   - Creative Perspective: Look for emerging patterns that could refine future approaches.

   *2.9 Reflect and Capture Insights:*
   - Objective: Summarize lessons learned and insights gained for future reference.
   - Reflection: "What new understanding has emerged from this process?"
   - Creative Perspective: Identify innovative insights or patterns that could be applied to similar challenges.

3. *Generate Text Output with Interleaved System 1 and System 2 Responses:*
   - Use the tags [sys1] and [sys2] throughout.
   - Aim for a lengthier, detailed response. Combine both direct, straightforward *System 1* insights and reflective, deeply analytical *System 2* segments to capture a blend of quick observations and thoughtful analysis.

---

### *Example Input Text:*

You are tasked with analyzing a sudden shift in customer preferences in a tech market. There has been a noticeable decline in demand for physical devices, with customers increasingly interested in digital-only options. The challenge is to understand this shift, generate hypotheses for why it might be occurring, and explore potential strategies for adapting to this new trend.

---

### *Processed Output with System 1 and System 2 Thinking:*

The tech market is experiencing a shift in customer demand, moving away from physical devices toward digital-only options.

[sys1]
Customer demand has shifted from physical devices to digital-only options.
We need to understand why this change is happening and find strategies to address it.
Key factors may include cost, convenience, and technological trends.
[end sys1]

[sys2]
**2.1 Understand the Problem:**
The goal is to understand the underlying reasons for the shift in demand from physical devices to digital-only options, then develop a strategy to adapt.

*Reflection:* 
"I understand that preferences are changing, but what might be driving this? Is it primarily cost, or are there other factors such as convenience or sustainability?"

*Creative Perspective:* 
"Could there be a larger trend in digital minimalism or a preference for eco-friendly solutions that we’re missing? What unseen motivations might explain this shift?"

**2.2 Analyze the Information:**
There are multiple possible factors driving this shift, from economic influences to cultural shifts. It’s essential to isolate each factor and understand its impact.

*Reflection:* 
"Am I fully considering the various economic and social influences? Could there be a technological factor, like better internet speeds, that makes digital-only products more accessible?"

*Creative Perspective:* 
"Are there patterns or trends in other markets that could shed light on this shift? Could this be part of a larger trend toward virtual experiences?"

**2.3 Generate Hypotheses:**
1. Customers prefer digital options due to lower costs. (Confidence: 0.8, Creative: 0.4)
2. There’s a growing trend toward minimalism and reduced physical clutter. (Confidence: 0.7, Creative: 0.7)
3. Digital products offer greater flexibility and ease of use. (Confidence: 0.6, Creative: 0.6)
4. Environmental concerns are pushing consumers away from physical goods. (Confidence: 0.6, Creative: 0.8)
5. Advances in tech make digital-only options more functional. (Confidence: 0.8, Creative: 0.5)
6. Pandemic-era remote work increased demand for digital solutions. (Confidence: 0.7, Creative: 0.6)
7. Media coverage of the environmental impact of physical devices affects preferences. (Confidence: 0.5, Creative: 0.7)
8. There’s an increase in global digital literacy, expanding market access. (Confidence: 0.6, Creative: 0.6)
9. Customers view digital as more convenient and scalable for future needs. (Confidence: 0.7, Creative: 0.5)
10. Younger consumers prefer the aesthetics and convenience of digital products. (Confidence: 0.6, Creative: 0.6)

*Reflection:* 
"Have I considered all possible influences? Are there any surprising factors that could explain this shift?"

*Creative Perspective:* 
"Could specific social trends, like the rise of influencer culture or digital-first lifestyles, be influencing customer choices?"

**2.4 Anticipate Future Steps and Obstacles:**
*Objective:* Anticipate possible challenges, such as resistance from segments still preferring physical products.

*Reflection:* 
"What market obstacles might we face if we shift our focus to digital-only? Are there sub-segments that still prioritize physical products?"

*Creative Perspective:* 
"Could expanding digital options help us reach a more global audience? Are there emerging trends that we could leverage in our strategy?"

[end sys2]

[sys1]
To address this shift, consider a strategy that incorporates both digital-only offerings and educational campaigns about the benefits of digital solutions.
Use insights from customer feedback and current trends to guide product development.
Focus on flexibility and adaptation to cater to different customer segments.
[end sys1]



156 Mich. App. 405 (1986)
402 N.W.2d 23
PENDELL
v.
JARKA
Docket No. 85807.
Michigan Court of Appeals.
Decided December 1, 1986.
Frank Stanley, for plaintiff.
Dykema, Gossett, Spencer, Goodnow & Trigg (by Jane E. Markey and Mary L. Cawley), for defendant Robert W. Jarka, M.D.
Kitch, Saurbier, Drutchas, Wagner & Kenney, P.C. (by Susan Healey Zitterman), for defendant St. Mary's Hospital.
Before: D.E. HOLBROOK, JR., P.J., and WAHLS and M.E. DODGE,[*] JJ.
PER CURIAM.
On February 21, 1984, plaintiff, Harold J. Pendell, filed a medical malpractice action against defendants, Robert W. Jarka and St. Mary's Hospital, in the Kent Circuit Court. By order entered on May 20, 1985, the trial court *407 granted defendants' motion for summary disposition, holding that the applicable period of limitations barred plaintiff's suit. MCR 2.116(C)(7). Plaintiff appeals as of right.
Plaintiff injured his shoulder in April, 1981. He was treated by defendant Jarka, an orthopedist, between April and August, 1981. On August 23, 1981, Jarka performed a closed manipulation procedure on plaintiff's shoulder at St. Mary's Hospital. On October 8, 1981, plaintiff underwent surgery at St. Mary's to prevent chronic dislocation of his shoulder. Thereafter, he attended physical therapy for approximately three weeks and had three follow-up visits with Jarka, the final one being in November, 1981. On December 29, 1981, plaintiff returned to Jarka with complaints of numbness in his fingers. Jarka referred plaintiff to Dr. Gracias, a neurologist. In February, 1982, apparently dissatisfied with Gracias' treatment, plaintiff went on his own initiative to the Mayo Clinic. To this end, on February 25, 1982, plaintiff requested and received a letter from Jarka, directed "To Whom it May Concern," outlining the care and treatment rendered plaintiff by Jarka. At this time, plaintiff also received copies of his medical records from Jarka. Plaintiff was subsequently treated at Mayo Clinic.
Sometime between January and June, 1983, plaintiff consulted with an attorney because he thought a mistake had been made in the closed manipulation procedure. In February, 1984, a physician was retained to evaluate plaintiff's claim and advised plaintiff that the manipulation had, indeed, been improperly performed. Plaintiff then filed the medical malpractice suit on February 21, 1984. Thereafter, defendant Jarka filed a motion for summary disposition pursuant to MCR 2.116(C)(7) on the ground that plaintiff's action was *408 barred by the applicable statute of limitations. Defendant St. Mary's subsequently joined the motion. The trial court agreed with defendants and accordingly granted their motion.
Claims for malpractice must be brought within two years after the last treatment by the defendant or within six months after discovery of the malpractice claim. MCL 600.5805(4), 600.5838; MSA 27A.5805(4), 27A.5838. Accural of the claim with respect to the two-year period is governed by MCL 600.5838; MSA 27A.5838, which in pertinent part states:
(1) A claim based on the malpractice of a person who is, or holds himself out to be, a member of a state licensed profession ... accrues at the time that person discontinues treating or otherwise serving the plaintiff in a professional or pseudoprofessional capacity as to the matters out of which the claim for malpractice arose, regardless of the time the plaintiff discovers or otherwise has knowledge of the claim.
We first note that in his brief on appeal plaintiff has focused completely on defendant Jarka to the exclusion of St. Mary's Hospital. The date of plaintiff's last treatment by St. Mary's was sometime in late September, 1981. Plaintiff makes no claim that Jarka was an employee or agent of the hospital or that the hospital is in any way vicariously liable for Jarka's actions. Since plaintiff filed his complaint on February 21, 1984, more than two years after the hospital's last treatment of plaintiff, we find that his suit against the hospital is barred by the two-year limitations period.
With respect to Jarka, plaintiff contends that the doctor's actions on February 25, 1982, in turning over medical records to plaintiff and preparing the referral letter outlining his treatment of plaintiff *409 and his actions around February 22, 1982, in reviewing medical reports sent from Dr. Gracias, constituted "treating or otherwise serving" within the meaning of § 5838.
Plaintiff relies on several prior decisions of this Court in making his argument. We find these to be factually distinguishable from the within case. In both DeGrazia v Johnson, 105 Mich App 356; 306 NW2d 512 (1981), and Shane v Mouw, 116 Mich App 737; 323 NW2d 537 (1982), the Court pointed to the fact that there was no evidence of any occurrence between the parties prior to their phone conversations which would indicate that the physician-patient relationship had ended. DeGrazia, supra, p 360; Mouw, supra, p 741.
Instead, we find the recent case of Bosel v Babcock, 153 Mich App 592; 396 NW2d 448 (1986), to be helpful. In that case, the defendant doctor transferred plaintiff to a different hospital to be treated by different doctors on February 26, 1982, after his own treatments proved to be unsuccessful. Subsequently, the plaintiff went to the defendant's office on April 14, 1982, in order to return some of the equipment owned by the defendant which was related to the defendant's treatment of the plaintiff. At that time the defendant recommended a physicial therapy service to the plaintiff. The plaintiff contended that this visit constituted "treating or otherwise serving" thereby tolling the statute of limitations. This Court disagreed holding that, due to the occurrence of the transfer of plaintiff to another hospital to be treated by another doctor, defendant discontinued treating or otherwise serving plaintiff and the statute of limitations began to run on that date.
Bosel follows the essence of the last treatment rule which is that the cessation of the ongoing patient-physician relationship marks the point *410 where the statute of limitations begins to run. Heisler v Rogers, 113 Mich App 630, 633; 318 NW2d 503 (1982). When the ongoing doctor-patient relationship and its accompanying air of trustfulness in one's own doctor ends, the statute of limitations begins to run. Heisler, supra, p 634.
In the instant case, the actions of the parties indicated that the ongoing physician-patient relationship and its accompanying "air of trustfulness" terminated prior to the February 25, 1982, visit. On December 29, 1981, plaintiff was referred by Jarka to Gracias because, as an orthopedist, Jarka was unable to treat plaintiff's complaints of numbness. When plaintiff decided that he was dissatisfied with Dr. Gracias' care, he did not return to Jarka for further treatment but, rather, went on his own initiative to the Mayo Clinic.
We conclude that the referral on December 29, 1981, of plaintiff by Jarka to a different doctor constituted the cessation of the "ongoing physician-patient" relationship between plaintiff and Jarka. At this point the statute of limitations began to run. The air of trustfulness between doctor and patient did not exist on February 25, 1982, when the plaintiff's only purpose was to obtain his medical records and past history to facilitate his treatment by another doctor. See, e.g., Juravle v Ozdagler, 149 Mich App 148; 385 NW2d 627 (1985). By his own admission plaintiff sought the records and report to facilitate his care at Mayo Clinic.
Plaintiff suggests that Jarka's review of the letters sent by Doctor Gracias concerning the latter's treatment of plaintiff (which could possibly have been later than February 21, 1984) constituted "treating or otherwise serving." To the extent that dicta in Penner v Seaway Hospital, 102 Mich App 697; 302 NW2d 285 (1981), lv den 417 *411 Mich 974 (1983), suggests that this is an appropriate rule, we decline to follow it. Referral of patients between physicians for any number of reasons is a common practice. Oftentimes, as in this case, the referral constitutes the cessation of the patient-doctor relationship and review of the second physician's report is merely a professional courtesy. Such a review does not necessarily mean, however, that the original doctor intends to resume treatment of the patient. To allow such a minor act to constitute "treating or otherwise serving" the patient within the meaning of § 5838 would invite abuse.
In the factual situation presented herein the trial court did not err in finding that Jarka discontinued treating or serving plaintiff on December 29, 1981, and in concluding that plaintiff's cause of action accrued on that date. Consequently, plaintiff's suit, commenced on February 21, 1984, was barred by the applicable limitations period and the trial court did not err in so concluding.
Plaintiff next contends that his suit is not barred by the statute of limitations under the date of discovery rule, MCL 600.5838(2); MSA 27A.5838(2). That statute provides that a malpractice action may be commenced within six months after the plaintiff discovers or should have discovered the existence of the claim. Plaintiff asserts that he did not discover his injury until February, 1984.
Summary disposition grounded on the statute of limitations is improper when material factual disputes exist with regard to discovery of the asserted malpractice. Heisler, supra, p 635. In Leyson v Krause, 92 Mich App 759; 285 NW2d 451 (1979), this Court noted the contrary rule:
We note that, if the undisputed facts revealed *412 that the claim was barred by the statute of limitations (i.e., had plaintiff admitted in her deposition that she realized in 1971 that defendant had breached the applicable standard of care), the issue would be a question of law which is within the exclusive province of the court, even where a jury trial is requested. [Leyson, supra, p 765, n 2.]
This Court has held that in order to discover "asserted malpractice" a person must know of the act or omission and have good reason to believe that the act was improper or was done in an improper manner. Leary v Rupp, 89 Mich App 145, 148; 280 NW2d 466 (1979). See also Jackson v Vincent, 97 Mich App 568; 296 NW2d 104 (1980); Leyson, supra.
We find the evidence to be undisputed here that plaintiff knew of his claim well before the six-month period prior to instituting suit. Plaintiff admitted in his deposition that he first thought he had a claim against Jarka after the closed manipulation procedure was performed but before his surgery in October, 1981. At the very latest, plaintiff admitted that he had thought about bringing a lawsuit while he was still undergoing treatment with Jarka. This indicates that plaintiff knew of a possible claim two years prior to the date he filed his complaint. Therefore, we conclude that plaintiff's claims against both Jarka and the hospital were barred by the six-month discovery rule.
Affirmed. Costs to appellees.
NOTES
[*]  Circuit judge, sitting on the Court of Appeals by assignment.