We have spoken a number of times about our perception of reality and how this changes the way we view the world and act in accordance with this world view. In a previous discussion the idea of predictive coding was highlighted. That is the idea that our prediction of a situation influences the way in which we prepare act and behave within that situation. But what happens when our prediction is not quite right?
Something that has become apparent is that our assumptions often lead to ineffective approaches in healthcare. Now this is not a new finding. It has been known for a long time that the decision making process in healthcare is mired in errors. And most of it comes down to the inherent biases that we bring to these decisions. Many of them often exist and are perpetuated as we gain experience. So how do we maintain objectivity?
A recent experience that highlighted this within our own setting is the use of objective testing equipment within our assessment protocols. The use of equipment such as force plates, dynamometry and in depth video analysis tools, has shifted the overconfidence that many of our team had in their perception of situations before they completed the testing.There have been a number of occasions in which based on our subjective findings the expectation is that a client will be stronger, weaker, have higher or lower rate of force development or even stiffness properties in the injured tissue (joint, muscle, tendon structure) than what the reality of testing shows. On these occasions it is not uncommon that the findings are the complete opposite of what was expected. An example may be that an injured tendon complex occurs within a tissue that is weaker than the uninjured limb. In a significant number of cases, this is the complete opposite of what is found. A common finding is that the injured side functions and has output at a significantly higher level that the uninjured limb. Now when you receive this finding it is easy to rationalize the outcome and suggest that it makes sense for this to be the case. But what many of us will often not do is suggest that we expected that result prior to the testing.
This along with other findings has made us question our ability to remain objective and what behaviours may assist in this process, particularly in healthcare and performance decision making. So how do we remove these biases and errors in our approach?
Thankfully these very errors have been discussed and there does appear to be strategies that you can use to address the possibility of losing our objectivity in decision making. A paper by Croskerry and Norman, 2008, highlights some key strategies that ask individuals to explore tactics such as looking for contrary evidence to refute their original hypothesis, listing and highlighting our biases through the assessment process and embracing the uncertainty of not having the answer immediately, and in many cases making this a reasonable outcome within the environment. One key strategy that has assisted our practice has been asking a colleague without any prior knowledge of the situation to review the data collected and come to their own hypothesis. The trick here is to not give them any background or handover information. Whilst it may seem overly time consuming, asking a few questions when unsure may make all the difference in identifying areas in which we have made fatal assumptions in our decision making.
Objectivity should be an inherent part of our practice in healthcare and sports performance, but as with all humans we are at risk of falling prey to our own biases. So before jumping to conclusion, ask yourself am I being objective, and what can I do to remove the risk of assuming an outcome too early.
Croskerry, P., & Norman, G. (2008). Overconfidence in clinical decision making. The American journal of medicine, 121(5), S24-S29.