Truth and Dare

Conspiracy theories and fake news are seemingly ubiquitous in social conversations and media reports these days. Facts must be approached with caution, and checked to confirm veracity. Public opinion can easily be swayed by use of various cognitive biases.

Healthcare workers and therapists are not immune to this concept. Confirmation bias suggests we favor and seek answers that affirm our pre-existing beliefs. Advertisers online take advantage of this by matching their ads to our past searches, which is called “behavioral retargeting”. This can manifest itself in patient examination when we look for our usual or preferred impairments, so that we can provide our comfortable therapy treatment routines. Just like we may repeat similar purchases, we repeat similar impairment lists. Likewise, we may give in to similarity bias, or the belief that all our patients are more similar to each other than different, allowing us to treat them all the same. Other times, we become susceptible to authority bias when we are influenced by the opinion of a clinical or medical leader, or perhaps the availability cascade takes effect when a suggestion accumulates more credibility as it spreads among our colleagues.

Vulnerability is amplified by the Dunning-Kruger effect, which states that the less we know the more confident we are. We all want to be right. Until we find out we are wrong. This is reinforced by our experiences and the learning paradox that the more we learn, the less we know. Certainly, as we explore the limits of our wisdom, we concurrently become more aware of our ignorance. This is something to celebrate. We need to embrace this discovery, and use it as motivation for the expansion of knowledge.

In reflecting on your own practice, this may require a return to the literature or compel us to find continuing education courses for ongoing professional growth. It likely means asking yourself more frequently why you do the things you do, why you think the things you think, or even why you may not always achieve the outcomes you desire. 

It is possible that unconscious bias (also known as implicit bias) has corrupted our expertise or that we have settled for complacency. These attitudes or behaviors affect our understanding, actions, and decisions even involuntarily. Quality and safety are often unintended sacrifices. Bias is comfortable and makes things easy for us so we do not have to consciously put effort into thinking all the time. It hijacks and sabotages our ability to be open. Although expedient, patients are the victims. They need us to think. They need us to know. We need to avoid the bias trap, and overcome our own thinking. 

The intervention for this is advancement of your learning, deepening your mastery of foundational sciences, examining the root cause, and testing your facts. I dare you to be different, to stray from groupthink, to be a non-conformist, and to think harder and know more than the average clinician. Our goal should always be to find the true underlying reason a patient cannot do what they want to do…and the truth shall set them free.