As Physiotherapists, we often rely on our current knowledge and previous experience to make decisions regarding patient care. However, even the most seasoned practitioners can fall prey to cognitive biases – the tricks our brains play on us that can lead to flawed decision-making. In fact, cognitive biases are prevalent in various areas of our lives, and clinical decision-making is no exception. They can cause us to jump to conclusions, make hasty judgments, and overlook important details, all while we believe we are being logical and objective. In this blog post, we will explore the concept of cognitive biases and how they can impact our clinical decision-making, highlighting the importance of employing systematic and evidence-based approaches in our practice.
Confirmatory bias
Confirmatory bias refers to seeking information that supports our existing beliefs or expectations while ignoring or dismissing information that contradicts them. In a clinical setting, this can manifest as a reluctance to ask questions or explore alternative hypotheses once we have formed an initial impression of a patient’s condition. To avoid falling into this trap, it’s essential to actively seek information that challenges our assumptions and consider it in our decision-making. By asking questions that may contradict our early hypotheses and treating all information as relevant, we can guard against the influence of confirmatory bias and ensure that our clinical decision-making remains objective and evidence-based.
The availability heuristic
The human brain is a remarkable thing, capable of processing vast amounts of information and making rapid-fire decisions that help us navigate the world around us. But despite its many strengths, the brain is also prone to certain biases and shortcuts that can sometimes lead us astray. One of these biases is known as the availability heuristic.
The availability heuristic is a mental shortcut that involves making judgments based on how easily we can recall or imagine certain events or experiences. In other words, we tend to overestimate the likelihood of something happening if we can easily think of examples of it, and underestimate the likelihood if we can’t think of any examples off the top of our heads.
For example, if you just read an interesting case report on the clinical presentation of baxter’s nerve entrapment, unconsciously, you will automatically assume that future patients you assess that present with posterior heel pain must have baxter’s nerve entrapment. In the moment, it may feel like the most obvious thoughts that come to mind are likely to be common and accurate, but it is possible that your brain is leading you astray. To prevent this, you should question whether the information that comes to mind is truly relevant, rather than simply readily available.
Illusory correlation
This is the tendency to link two events as cause and effect, even when they are coincidental or have no connection. This can overlap with confirmatory bias, where people interpret outcomes that fit their pre-existing ideas. For instance, some may claim that neck massage works when a patient gets better after taking paracetamol for example, despite no solid evidence. Some therapists might recall these instances when a patient improves after treatment, leading to the illusion of correlation. It is crucial to avoid such incorrect beliefs to prevent sub-optimal clinical practice. When making decisions about patient care, use evidence-based practices and guidelines rather than relying on anecdotal evidence or personal experiences to avoid making false correlations.
Audacity
Although many of us may believe that we are experts in our respective fields, it is important to understand the limitations of our knowledge in order to use it effectively. Failure to identify gaps in our knowledge can lead to sub-optimal patient care which can potentially result in harm to patients. Therefore, it is crucial to recognise the boundaries of your knowledge and regularly ask for colleagues’ opinions and conducting your own research on the best available evidence. Developing a habit of seeking advice and keeping up-to-date with the latest information is essential for avoiding these potential pitfalls.