Critical Thinking

The Experience Wall Part 3

This post is a continuation of “The Experience Wall” series of posts. You can check out the first 2 posts here and here. In the first post I spoke generally about experience and broke it up into 3 parts.computer memory

1)       The perception of clinical events (seeing, hearing, feeling, etc)

2)       The memories of those events

3)       The interpretation of those perceptions (cause and effect, etc)

This post will look at memories in more detail.

Just like with perception, it is easy to feel that our memories are accurate and unaffected by our biases. However it turns out that memory is often inaccurate and influenced by beliefs, biases and perspective. In this article and this book Daniel Schacter describes “The seven sins of memory” These seven sins describe 7 ways our memories fail us.

seven memory sins

Sometimes these failures of our memory are very obvious. For example, forgetting the name of someone you have not seen in years or losing your car in a mall parking lot. Other times, errors in memory go undetected. These hidden errors have been highlight by lost in the mall studies. These studies expose a person to fictitious stories about them being lost in the mall as a child. After hearing this enough times (often told by relatives) they adopt the memory and truly remember that it happened (even though it didn’t), sin #5.

These hidden errors in memory are dangerous because we are often very confident that our memory is accurate, even though it is not. This over confidence can lead to serious errors, such as those seen with eye witness testimony. The confident testimony of eye witnesses has resulted in numerous convictions, which have later been overturned by more objective information, such as DNA analysis.

These examples demonstrate that memory is incomplete, constructed after events and continually influenced and changed by our current needs, biases and expectations. Furthermore, extreme confidence in a memory is not strongly correlated with the accuracy of those memories.

Memory of past patients and past outcomes makes up a big part of clinical experience. We use our recollection of past cases to make judgments on diagnosis, prognosis and treatment effectiveness. Unfortunately, we may be more likely to remember patients who got better and less likely to remember those who did not (or vice versa). This can leave us with a skewed and biased view of our past performance.  For example, a clinician may remember that in the past “correcting” an anteriorly rotated pelvis has been very effective. However, due to bias or other errors of memory, the clinician may have forgotten all of the cases in which this “correction” did not work.

As with errors in perception, errors of memory cannot be avoided. We have to understand that our recall of events is imperfect and adjust our confidence in memory accordingly.

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3 replies »

  1. This could not be more true. In the physical therapy world and in particular the treatment of back and neck problems, the perception of success has been dramatically skewed. Therefore we need tools to assist in the decision making process and help objectify results, such as standardized outcome measures. For years every PT in the country has believed they are solving their patient’s back and neck problems. However, this perception has been based on memories of some successful patients and not truly based on significant amounts of objective data. I’ve asked this question quite often while teaching courses the past few years and I typically get the same general responses “my patients love me” or “my system is as good as any and probably better than most.” As PT’s we are in the business of helping people, no doubt about it. All of us are helping various people from all walks of life. But if we want the profession to continue to develop and grow and truly become autonomous we need to have objective data to support the need for our services and to demonstrate the real value we can bring to patients and to the healthcare marketplace.

  2. […] It is time to wrap up this series I have called the “The Experience Wall.” The goal of these posts has been to highlight how, despite an illusion of accuracy, our experience can often be misleading and biased. This can lead to over confidence and experience can become a barrier to growth and development as a clinician. If you have not seen the first 3 posts check them out here, here and here. […]

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