Illusory Superiority and Medical Decision-Making

Illusory superiority is the bias that most of us, including myself, have about our abilities or thinking capabilities. Study after study has proven this. In the ficitional Lake Wobegon, for example, all the children are above average. The majority of students in nearly all studies of intellect think they are above average; in one study 25% of students thought themselves in the top 1%.

I began to wonder how this affects our medical decision-making. Do we make stupid or ill-informed decisions about our health because we think we know more than we do? I personally think that forums like this PCa forum can be exceedingly useful in providing a collective counterweight to our own biases.

I recently encountered an example of this regarding a financial decision about when to take Social Security. I thought I knew a lot, but my illusory superiority kept me from learning additional information important to the decision.

We have all faced this when we were told we had prostate cancer. And the initial kick to the gut that the news brings, with the resulting fear of the unknown, can skew our rational, decision-making capability.

As for me, I'm not among the 25% who think themselves in the top 1%, but I'm definitely above average.

Yes, but below average of what? Below average on intellectual ability of the general populace..I doubt it.

Not me!...tee hee!

halbert said...
One of the most difficult things any person can do is admit ignorance. Especially when the reality is that not only are there many things we don't know because we haven't figured them out, there are many things we don't know because it never occurs to us that we could know them...that we haven't even figured out what the question should be.

Illusory superiority is only one problem we suffer from. Confirmation bias is another one--which in my definition is the tendency to only listen to those who tell us things we can agree with..or to only look for answers that confirm what we already believe to be true. Data that does not support the hypothesis is to be discarded.

In short, we all suffer from cranial-rectal inversion to some degree.

Confirmation bias certainly plays into our decision-making. Something else that has occurred because of Internet access to medical information is that we may think that excavating for information on the Internet makes us better decision-makers than our doctors. While a medical decision is at-best a shared decision, we can tend think that our extensive research has made us more knowledgeable and thus ignore or deprecate our doctor's opinion based on many years of medical training and experience.

PSA,

I really liked the video. Thanks!

Thanks for the video. Many times, when a doctor, or other professional, tells us that we're in a hopeless condition they're really saying that they are out of answers. They don't like to admit ignorance any more than the rest of us do, the problems come when they tell us that there aren't any answers out there.

The best ones...and they are rare...are willing to admit that they've taken us as far as they can. And that should be OK.

This is a valuable thread and conversation to have.

Great video, gave me chills when I saw Arthur run.

This thread is interesting and it made me think of a comment I've made to a Dr here and there, to the effect of "I should have been an engineer, I'm a data junkie". It sounds Sort of like making an excuse, and apologizing for knowing way more than most of their patients. Which we shouldn't do.

But it also makes me think, should our job as patients, as our own advocates, be to just find highly skilled and cutting edge doctors, that we feel comfortable trusting, and let them take it from there, so we can just focus on healing? Sometimes I think that's the case. But there is probably a balance between being trusting of our Drs and being informed.

The biases discussed here do make a case for us not making our own decisions, on some level. I'm not advocating that, completely. But as I said, there is probably a balance, somewhere

I always approach my doctor with a question for clarification of what I think I understand vs what he knows. The better ones will say they do not know it that is the case. My most recent question was to a research doc on why my PSA would drop 97% yet the scan would only indicate a 10% reduction in tumor size. If PSA expression is a measure of tumor burden then why is there not a corresponding drop unless the med is only suppressing the tumors ability to produce PSA. Got an answer but not sure I fully signed on to it.

I also find the young doctors to be less inclined to admit ignorance than the older ones. But they do have the latest information in many cases even if they have not seen many cases.

The video was inspiring. Thanks for the link.

Don

don826 said...
.............My most recent question was to a research doc on why my PSA would drop 97% yet the scan would only indicate a 10% reduction in tumor size. If PSA expression is a measure of tumor burden then why is there not a corresponding drop unless the med is only suppressing the tumors ability to produce PSA. Got an answer but not sure I fully signed on to it.

I also find the young doctors to be less inclined to admit ignorance than the older ones. ................

What was the answer?

Just before my discharge after my RP, one of the younger URO residents came in to check me out and asked if I had any questions. I asked him: "Do G6s someday grow up to be G9s, or are G9s born a G9?". I think I literally ruined his day. He had no clue what the answer was, it was clear he had never heard the question discussed before. He seemed very embarrassed that he did not know, or maybe that a patient could ask a question related to PC of which he would be totally ignorant. I felt bad for him.

BillyBob,
The essence of the answer was that the drugs are being developed as alternatives to chemo that have less debilitating effects than chemo and are at least as good as chemo for treatment. Mostly palliative while conserving quality of life a bit longer. I found it odd that cure was not mentioned and did not want to be argumentative.

On another note regarding curative intent I read an article some time ago that said over 1700 new drugs had been approved in the previous ten years and not one had curative intent. They were all designed to turn the malady they treated into a "manageable chronic disease". I read this as "ATM" for the docs and big pharma. Sorry, I am being rude.

Don

So far no one has mentioned the 800-pound gorilla in the room that has become the most significant force in history so far in the collection and dissemination of information, and the role it has come to play in our thinking about what we believe we know or don't know.

The Internet.

When I started in academic librarianship in 1972, all we really had back then to manage the collection and dissemination of information was big old bulky card catalogs and paper-printed books and journals. Computers at that time were big, primitive mainframes housed away in campus buildings somewhere, frankly of limited capabilities, and there was nothing available to either us librarians or to the public in the way of personal computing machines, as there is now.

And, as you would imagine, information retrieval in those days was slow, incomplete, and by today's standards, entirely unsatisfactory.

Then came computers, primitive at first, but eventually devices available for everyone to use. Automation of library catalogs took off in the early 1980s, and since then virtually no one has ever looked back as one information retrieval marvel after another has just kept coming and coming, leading us up to where we are today.

Then came the Internet, now here for barely twenty years so far (doesn't it seem longer than that?), with the colossal impact it has had both on information control and on our lives.

For purposes of this current thread, this has meant that vast quantities of medical information (some valid, some dubious, granted) are literally keyboard strokes away from anyone who has web access.

Of course with the impact of this universe of medical knowledge thrown open to the world, coupled with advanced searching capabilities, real time updating capabilities, practically infinite data storage capacities, and the list goes on and on, the inescapable result is that we are all truly challenged to understand just what our own limitations are in the matter of knowing what we know, or don't know. This is because a virtual flood of information can come at us every time we do a web search.

Because the Internet has changed everything.

Now we can get almost information-drunk on the seemingly endless data available 24/7 on the web. And presumably the net will only continue to grow in size and sophistication. Amazing new tools will be added almost daily. There will be AI programs coming soon of such sophistication that today's "advanced" Boolean searches will come to seem like mere toys to future users.

So I really believe that we can be pardoned a bit if we might err in thinking that we know more than we really do, especially as we have been made, as noted, virtually intoxicated by the panorama of facts and knowledge that the web has come to offer us whenever we want it.

So the facts of our (or anyone's) medical situation are there and available to us as they have never been before. The challenge we now face is how to interpret and use them correctly.

Very few people can solely use logic to come to decisions because our biases influence the way we process information.
There was some research in which people with a strong belief in something were given facts that were contrary to their belief while under an MRI. In all cases in which facts were contrary to a held belief those thoughts were processed in the emotional part of the brain and never entered the part of the brain in which logic occurs.
Politicians have used this well in making emotional appeals rather than logical appeals in order to change peoples minds.
Beliefs or bias are emotional not logical processes and arguments of logic are rarely effective in changing bias or beliefs.

This thread bothers me.
It seems like one big putdown.

Here's a contrary opinion:

The average person on this forum (other than the newly diagnosed) is VERY knowledgeable. I am tired of reading the "we are not as smart as we think we are" mantra. That's hogwash. Most of us know a lot and we also realize there are loads of grey areas/unanswered questions.

In fact, my family doctor long ago stated that I know more about PC and the latest stuff than he does and even my general urologist (who treats MANY urological issues) has said the same.

Do I think I am smarter than I am? Heck no. The more I read the more questions I have. The smartest thing we can do is consult with even smarter people/experts.

Stop putting yourselves down!

Mel

Post Edited (compiler) : 7/15/2015 7:47:05 AM (GMT-6)