When I started PT school, I knew this is where it would take me.
Bad joke. Let me explain.
Spent my whole life ignoring things like metacognition, because I preferred more discrete sciences. Love answers. Real answers. But have, slowly, become enamored with social science and why we think and do the silly things we think and do, and how behaviors and thinking change over time. Like a playground for my brain! Errors in thinking... I make a great many errors.
What caught me about this, and why I decided to join the conversation on soma, is a book I've been reading about cognitive errors in the assumptions we create constructs of ourselves and the world around us. The chapters on Hindsight bias and Confirmation bias have taken a lot of my brain power lately. The book is "You are Not So Smart."
I suspect that some errors in clinical decision making come from the minds innate need to make sense of the world quickly to move on to the next stimulus.
Clinicians are trained (I just finished school, but hope never to finish training) to rely on "clinical decision making." Human make decisions, which are subject to every kind of bias I've ever heard of. Confirmation bias and hindsight bias (narrow spectrum, I know) work together to affirm our mistakes in thinking. A perfect storm for error! Hindsight works like this: an event/result/outcome happens. In reflection, certain events stand out leading up to the incident. You, being the reflective practitioner you were trained to be, try to construct patterns from randomness. This is where it falls apart. Hindsight bias is "I knew it all along". It's ignoring how you were wrong previously - taking from coincidence facts and ignoring other data to convince yourself you expected the outcome. Confirmation bias is "I bought a honda, now all I see is hondas! I must have bought a great car!"
The worst errors are of oversimplification (for the intent to do good!) of complex models to simpler ones. This allows them to "see more" and explain more, and rationalize their own clinical decision making. To say "I knew that you would respond to ____" all along. And a strong bias from then on to find evidence to SUPPORT instead of refute their newly constructed world view. Confirmation bias is the reason my dad woke up every morning at 5AM to listen to Rush with his morning news before work (politics aside). People look seek out things that agree with their world view to validate what they are already thinking. Couple that with a strong hindsight bias and you have the recipe for a guru. I will explain. A guru isn't believable because they are good liars. They whole heartedly believe that what they are telling you about piezoelectric effect when, in reality, most of what they are saying sounds very plausible because of a very plausible
sounding model of electricity. Or biomechanical models of spine pain. Or justification for ultrasound. Craniosacral therapy. I digress.
I am intrigued by the capacity of the brain to justify just about everything. Including writing this post.
It's worth noting that I have not even passed my board exam yet. Turns out I know a lot about neuro, musculoskeletal, and "other systems." But less about the foundational sciences of the cardio/pulm system and next to nothing about modalities. 3 of those things are interesting to me. 2 of them bore me to tears. One of them, as a category of intervention, is
mostly crap (so far as my education is concerned, but more independent research on my part should be done). Care to guess which one it is?
Also, I could use a good recommendation for a "review cardio for the NPTE" book, if anyone has anything. Thanks.
-d
