A Measure of Confidence

tag:blogger.com,1999:blog-5732322676995190327.post-91367663985145732052008-01-22T22:30:00.001+02:002008-03-31T05:18:42.184+02:00A Measure of Confidence<div align="center"><a href="http://img.mtv3.fi/mn_kuvat/mtv3/viihde/leffasivujen_kuvat/12419.jpg"><img style="DISPLAY: block; MARGIN: 0px auto 10px; WIDTH: 320px; CURSOR: hand; TEXT-ALIGN: center" alt="" src="http://img.mtv3.fi/mn_kuvat/mtv3/viihde/leffasivujen_kuvat/12419.jpg" border="0" /></a><a href="http://img.mtv3.fi/mn_kuvat/mtv3/viihde/leffasivujen_kuvat/12419.jpg">Photo</a>: Larisa Oleynik as Bianca Stratford and Gabrielle Union as Chastity in 10 Things I Hate About You <div align="center"></div> <div align="center">Chastity: "I know you can be overwhelmed, and you can be underwhelmed, but can you ever just be whelmed?" </div> <div align="center">Bianca: "I think you can in Europe."</div> These lines have been among my favorites from 10 Things I Hate About You, and today they took a turn for the profound as I substituted the word "confidence" for "whelmed" in an attempt to describe how I was feeling. For our epidemiology class, we read an article entitled "Five Pitfalls in Decisions About Diagnosis and Prescribing." It's about how doctors use (and misuse) heuristics - shortcuts in thinking that enable quick decision-making - in medical practice. (The article is written by a marketing professor, and is sponsored by a pharmaceutical that manufactures opiods, making at least the motives behind the paper suspect, especially when it's claimed that doctors "overestimate the risk of addiction when prescribing opiod analgesics for pain relief," thereby undertreating pain. But we'll ignore that for now.) Some of these heuristic "traps" are important for us as future doctors to be aware of, so that we're more conscious of our underlying biases and thinking strategies. For example, there's "confirmatory bias," meaning we have a tendency to notice and remember information that fits with our preconceived expectations - and dismiss information that does not fit those expectations. And there's the "availability heuristic," where we give greater weight to examples that come easily to mind, either because we recently encountered such an example or because it is particularly memorable, even if those examples are not very representative of the population or the disease. One heuristic mentioned in the article, however, tripped me up: Overconfidence. Doctors, and apparently most people, tend to be too sure of their own judgment. But I'm pretty sure that I err more on the side of underconfidence (unless I'm just turning a blind eye to instances when I'm overconfident). For instance, on Friday night, we were playing Battle of the Sexes with some friends, and the girls got the question, "What were four of the first seven domed stadiums built in the U.S.?" We had three of them down (Metrodome, Superdome, Astrodome), and were racking our brains for the fourth. One of the boys jokingly said, "Kingdome!" as if to throw us off, and I realized I had just read about the Kingdome and was struck at the time by how cheesily witty it was. I said this to the girls, but we weren't really sure if I was right. I doubted my memory (did Kingdome refer to something else?) and why would the boys help us get the answer right? But I was sure I had read about the Kingdome. In the end, we went with some made-up answer (Monsterdome), and got it wrong. This is a trivial example, but it is the most recent one (oh no, I'm falling prey to the availibilty heuristic already!), and other instances of this throughout my life have made me worry that when I'm a physician, I'll constantly doubt my own judgment. The implications aren't great: I might always rely on the advice of a colleague, even if he or she is less knowledgeable than I am; my patients, seeing my lack of confidence, may begin to doubt my capabilities; I may be paralyzed in my decision-making because I don't trust myself. In medical school, as in the article, it is emphasized that as physicians, we should never become proud, arrogant, or overconfident. Humility is promoted as one of the most important virtues of a good physician, and we're often reminded to retain our sense of awe for the mysteries of life and death, as well as our sense of humanity. I suppose it is true that most doctors, being highly-educated, well-trained, and powerful to heal, are more likely to be big-headed than otherwise, and a doctor's hubris certainly can incur harm for the patient. But we're not taught how to deal with underconfidence: how to actually gain the necessary measure of confidence to make patients (and ourselves) feel rightfully assured that a correct diagnosis is, in fact, correct. We don't learn how to break out of timidness and insecurity so that we're not constantly wavering and doubting our decisions. Maybe our professors assume confidence comes naturally with increasing amounts of knowledge, but that may not be true of all med students. In the next 3.5 years, that is something I hope to learn. Confidence. Not under-, not over-, but just plain, humble, reassuring confidence. It must exist, somewhere between the two extremes. </div>Kristinhttp://www.blogger.com/profile/12194078107819036706noreply@blogger.com