Cognitive errors and physical therapy

Thanks to Farnamstreetblog, I am getting into some good books (seriously, follow this guy on Twitter, subscribe to his blog, and read some of the books he recommends – it will cause personal and professional growth).  One of them is The Art of Thinking Clearly by Rolf Dobelli.  It is not intended to be a “how to” but rather “how not to” think poorly or commit cognitive errors. Each chapter consists of a different error, and I’ve recognized these either in myself or in those around me.  What I thought I would do is post a few of the 99 errors and how PT’s may or do commit these.  I’d highly recommend the book – it is a pretty quick read.  I currently have this from our local library, but it is one I plan to have on my shelf for a quick refresher or challenge.

  • Survivorship bias – we only see success around us, not the higher percentage of failures.   We need to dig for the failures to reduce our risk of overestimating our possibility of success.  Opening up your own clinic, going for a specialization, etc – go for it, but do your homework.
  • Confirmation bias – we interpret new information in light of our own beliefs or theories, discounting what doesn’t fit.  We need to question our own beliefs and theories.  Just because a patient’s symptoms indicate X condition, don’t ignore other symptoms that don’t fit your diagnosis.
  • Regression to the mean – good days and bad days average out (for pain, golf games, and finances).  A person’s improvement in a standardized test by X points means little if the MDC is X+1.  Know what detectable changes and clinically important changes are to be able to demonstrate meaningful change.
  • Black swan – an “unthinkable event that massively affects your life, your career, your company, your country” either positively or negatively.  Medicare changes over the last few years, the new healthcare law changes… Position yourself where you can ride a positive Black Swan (he gives an example of an entrepreneur with a scalable product), or if you are an employee avoid the negative by avoiding debt, investing conservatively, and live modestly.
  • Envy – resentment “toward those who are most similar to us in age, career, and residence.”  It is easy to be envious of others’ success in life both personally and professionally if you aren’t careful.  .  His suggestion is to “first, stop comparing yourself to others.  Second, find your “circle of competence” and fill it on your own.  Create a niche where you are the best.” Find your niche, whether you are working for others or for yourself.
  • Deformation professionnelle – Have you ever heard the phrase “to a man with a hammer, everything looks like a nail”? If you ask someone what the problem is, they will relate it to their area of expertise.  It is easy to point to surgeons and how they seem to default to surgery to fix things, but do we as PT’s do that, whether about PT in general or about our own specialty or favorite theory?  Maybe we should “better equip ourselves… try to add two or three additional tools to our repertoire – mental models that are far afield from our areas of expertise” (or comfort).  When I was a new grad, I’ll be honest that I leaned heavily on the evidence leg of the EBP stool – thankfully I think I’ve softened with time practicing and become more balanced as I’ve gained clinical experience.

What cognitive errors have you committed or seen coworkers commit?  Have they had any negative impact?


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