A basic tenet of science is that the truth can only be approximated. Experimental evidence helps us manipulate our environment, but there is always some uncertainty. Discomfort with uncertainty is an unhealthy cognitive bias.
Surgeons and their patients regularly make decisions based on probabilities. Part of the skill and safety of a surgeon is an awareness of uncertainty and the shortcomings of the human mind.
We studied these aspects of surgeon psychology using an overall recognition of uncertainty score and measures of trust in the orthopaedic evidence base, confidence bias (confidence that one’s skill is greater than it actually is), and statistical understanding. We found that overconfidence bias correlated with years in practice while recognition of uncertainty in daily practice did not (1). Less recognition of uncertainty had small correlations with working in a multispecialty group compared with academic practice, belief in God or any other deity/deities, greater confidence bias, and greater trust in the orthopaedic evidence base. Better statistical understanding was more strongly associated with greater recognition of uncertainty.
Limited recognition of uncertainty and high surgeon confidence bias might hinder adequately informing patients, informed decisions, and consent. Moreover, limited recognition of uncertainty is associated with modifiable factors such as confidence bias, trust in orthopaedic evidence base, and statistical understanding. This intolerance of uncertainty could also lead to ordering more diagnostic tests, thereby raising costs and increasing the risk of unhelpful treatments, a thesis that merits additional study. Perhaps improved statistical teaching in residency, journal clubs to improve the critique of evidence and awareness of bias, and acknowledgment of knowledge gaps at courses and conferences might create awareness about existing uncertainties.
References
- Teunis T, Janssen S, Guitton TG, Ring D, Parisien R. Do Orthopaedic Surgeons Acknowledge Uncertainty? Clin Orthop Relat Res. 2015 Nov 9. [Epub ahead of print] PubMed PMID: 26552806.