Tweeted by @mellojonny
"Premature closure? Not so fast"
http://qualitysafety.bmj.com/content/early/2016/03/15/bmjqs-2016-005267.full
learning about our flawed cognition keeps us humble.
Even Kahneman, Nobel laureate and the founder of the heuristics and biases field, says at the end of his 400-page book Thinking Fast and Slow that after 30 years of study, he is no better at avoiding these biases than he was when he started. He says he may now recognise a few situations where he is at risk of making cognitive errors, but like all of us, he is still better at seeing them in other people than in himself.
I wanted to emphasize this point-- it is SO important.
THIS is how
scientists operate and it's probably the thing about how Science Gets Done that is most alien to laypersons-- and this includes both healthcare
consumers as well as physicians-- and even the best-intended and most conscientious of clinicians is seldom (outside of those who have BOTH MD and PhD degrees, not the combo) equipped to truly understand and embrace it.
Scientists
must accept that their own interpretation/analysis is NEVER "The" answer. To anything. At best is it
An answer... a POSSIBLE answer. This is where statistics comes into things, btw... because (and this is another thing that too many people outside of the sciences fail to appreciate) some answers
are better than others, in that they are MORE likely to be true.
Again, these are things that the majority of patients and clinicians are not actually that accustomed to considering. In fact, physician training emphasizes
the exact juxtaposition of this mindset, in that doctors are expected to be Always Right at least with their patients, and they are expected to cultivate a culture of deference and reserve between themselves and patients.
That's NOT how science works. Science means that when I finish the paper I'm writing, my
peers-- starting with the ones that are "friendly" (being friends and colleagues) will
shred it, looking to poke holes in whatever I haven't thought sufficiently about, revealing bias and underlying errors left and right. Only AFTER that will outside reviewers be invited to do the same. By the time a publication reaches print/'net, ideally, at least 5-10 people have gone through it, nitpicking all the way. Now, it doesn't always happen the way that it should-- human institutions are great at becoming
too human in the interests of feelings, social connectivity, etc. but the PROCESS is pretty much ideal for dismantling bias and uncovering it where it's getting in the way.
The public often misunderstands this process-- that is, when one paper says ONE thing, and then another says just the opposite, or something that seems contradictory. Nope. It's not that they "can't make up their minds" or that they "aren't so smart after all" it's that probably NEITHER set of authors is entirely, um--
right. But also probably that both papers are 'true' insofar as the method and study design employed. Everyone knows this-- or should. Science is VERY messy, and nothing is ever "proven" with 100% certainty. Statistics, again, can only point out what is most LIKELY to be so.
That happens because the TRUTH is most important. It'd be great if physicians were trained to invite others to do this with their judgment and thinking, too. Diagnosticians and specialists are better about it than GP's, generally speaking, IME. But I think that might be because they see more complexity in their daily work, and it makes them understand that they don't always get the luxury of
certainty. Frankly, physicians should NEVER feel threatened by questions or by second opinions. NEVER.
Science is
all about second, third, fourth, and fifth opinions. Evidence-based medicine needs to be, too, if it seeks better
truth with greater efficiency. That's where I think that most medical practice still errs. It hopes for fewer human beings to be involved in the interests of "efficiency."
Hubris, that. Science
is the most efficient truth-seeking mechanism that human beings have ever devised. And it REQUIRES multiple participants, because each of them comes at a problem with different biases, previous experience, etc.
You can't skip that step and have it work.The best clinicians realize this, if only intuitively-- and INVITE collaboration with patients and families and other practitioners.