Critical Thinking

The Experience Wall Part 4

water dropIt 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.

Last but not least, this post will look at the judgments (namely cause and effect) that we make based on experience. To make sense of the world, our brains are constantly looking for patterns and associations. This can work really well in simple situations (limited variables) such as flicking a switch which causes a light to consistently turn on/off. However, in complex situations (as we see in the clinic) involving more variables, it is easy to miss real patterns and fabricate non-existing patterns.

Here is a common example I see from both students and clinicians. “I treated a patient with ultrasound (or insert any other treatment), the patient got better, so it must have been the ultrasound.” The problem with this statement is it ignores all the other potential relationships and jumps to a convenient conclusion. In order to accurately assess the likelihood of a cause and effect relationship we have to carefully consider all the possible explanations (or as many as we can think of) for the apparent change in the patient’s status. It is possible that the ultrasound caused the improvement; or it could have been the exercises, it could have simply been the natural course of the disorder, maybe it was placebo or maybe they really liked getting all that attention from you and that made them feel better. In this common clinical scenario, it is impossible to know why the patient actually improved. This is why anecdotes are not useful in determining the effectiveness of an intervention and it is why we need controlled studies.

The problem is that admitting we cannot reliably make cause and effect relationships based on our experience leaves us with uncertainty. As Joseph Brence discussed in his recent post, this uncertainty can be difficult to live with. However, it is this uncertainty which ensures that we do not let experience become a wall which blocks our growth as a clinician.

I don’t think that clinical experience is useless. However, clinical experience has lots of limitations and just like with research, we need to be critical consumers of our experience and the experience of others. I leave you with this video by Neil DeGrasse Tyson which sums up my last 4 posts with the word “brain failures”.

I hope that these series of posts were useful to read and look forward to hearing your thoughts on the subject.

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Categories: Critical Thinking

3 replies »

  1. I recall in residency being told that the three things, in order, that affect decision making in medicine, and I suspect it is similar in PT, are:
    1. Recent cases/experience
    2. Overall Experience and training
    3. Data – Evidence

    Unless we consciously choose to practice based on the data, our human nature relies on our recent and past personal experience. It fools us into thinking our small sample size experience is more important than statistically proven data Nice post.

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