Cognitive fallacies impacting physiotherapy. #Physiotalk 27th July 8pm.

Chat host.

This chat will be hosted by our guest Dr. Zachary Walston who serves as the National Director of Quality and Research at PT Solutions. His current primary roles comprise of overseeing research, developing and teaching continuing education courses, and developing quality improvement initiatives throughout the practice. He also serves as the Program Coordinator of the PT Solutions Orthopaedic Residency Program, the director of the Clinical Mentorship Program, and is on faculty for the Neurologic Residency Program. He currently serves on the APTA Science and Practice Affairs Committee. He has presented at multiple conferences on his research and the impact of cognitive biases on clinical decision making and patient outcomes.

Pre-chat summary.

Richard Feynman once wrote, “Scientific knowledge is a body of statements of varying degrees of uncertainty/certainty – some most unsure, some nearly sure, none absolutely certain.” Scientific curiosity, not scientific knowledge, must be the focus for clinicians to excel. School and continuing education courses are great for gathering new information, but the information can be applied in many ways. There is a lack of education on heuristics, biases, and cognitive fallacies. Clinicians bring their own experiences and perspectives to clinical situations, leading to differing opinions on the same information provided. It is imperative to know how to use the information we are given and how to navigate cognitive traps. Without a foundation for understanding information, our biases will take over. In relation, we need to be comfortable with doubt and uncertainty.

Patients also benefit from the understanding of these cognitive fallacies. The patients are often needed to hold clinicians accountable. Knowing the questions to ask and the ways they may be influenced by the same cognitive traps will improve the odds the best treatment is provided. During this chat, I will cover many of the common cognitive biases and fallacies clinicians and patients face every day. These include confirmation bias, availability heuristic, search significance bias, sunk-cost fallacy, theory-induced bias, loss aversion, and herd mentality. I will provide examples from my research and experiences to showcase identification and navigation of these fallacies.

What has made my experience unique is the three distinct roles I have filled: clinician, educator, researcher. You could loop in manager, but the other three are more applicable to the issues at hand. Combining those three roles with my experience as a patient provides an uncommon perspective. Furthermore, I have spent the last few years focused on the nuances that have led to a large gap between all three fields I have worked in: clinical care, academia, and research. Providing training to my colleagues in this area has facilitated significant improvements in our quality metrics and patient engagement scores. It has also fostered more robust clinical conversations and a culture of living clinically.

Chat questions.

Q1: What is an example of confirmation bias you have experienced in a healthcare setting? Could be a clinician or patient

Q2: What is the most common bias you fall victim to?

Q3: How do you confront someone clearly demonstrating a cognitive bias or fallacy when having a clinical debate?

Q4: How can cognitive fallacies, biases, and heuristics best be integrated into clinical education?

Q5: What are some heuristics that are beneficial in a clinical setting?

Transcript

Missed the chat? Catch up with the transcript here.

Useful resources.

https://www.researchgate.net/publication/51791121_An_overview_on_cognitive_aspects_implicated_in_medical_decisions

https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-016-0377-1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341653/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088215/

https://medium.com/swlh/every-chapter-of-thinking-fast-and-slow-in-7-minutes-5e6adf89cf39

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