“Just the facts, ma’am.” I intended to allude to the topic of this post – confirmation bias – with that well-known quote from Dragnet’s Joe Friday. Little did I know that it would be more appropriate than I ever thought.
I grew-up hearing the phrase but have never actually watched an episode of Dragnet so I wanted to be sure I attributed it to the right character. To my surprise, according to Snopes.com, Sgt. Joe Friday never said those words. He actually said “All we want are the facts, ma’am,” or “All we know are the facts, ma’am.” The phrase became condensed in the collective memory of American TV watchers and now we all remember it as “Just the facts, ma’am.” Unfortunately, the facts fly in the face of nostalgia but it’s likely the modified phrase will live on. Why? Because we believe it to be true.
Facts can be tricky things. Often they challenge our memories, belief systems and identities. If a researcher came to me and said there was scientific evidence that the Chicago Cubs were a better baseball team than the Chicago White Sox, I don’t think I could believe it, no matter what the evidence said. To suddenly accept the Cubs as the right way to play baseball would fly in the face of 38 years of allegiance to the South Siders. I’ve been indoctrinated since birth to be a Sox fan. You can’t just change that overnight based on facts can you?
In the world of psychology and science, the phenomenon of favoring information that supports one’s beliefs is known as confirmation bias. In my Cubs-Sox example, I’d simply refute any data the researchers had by saying, “Which team last won a World Series?” The answer: The White Sox in 2005.
Some non-Chicago-centric examples of areas where confirmation bias exists is vaccines and autism, climate change, President Obama’s country of birth, and even the moon landing. There are people out there who, despite facts to the contrary, continue to hold on to their beliefs, as illustrated in this animated video by Ronny Mukherjee.
Why would anyone who is presented with hard evidence choose to believe otherwise? The phenomenon of confirmation bias is covered in a Mother Jones article The Science of Why We Don’t Believe Science. The article talks about motivated reasoning which is built upon confirmation bias. While confirmation bias rejects evidence contrary to one’s beliefs, motivated reasoning is an emotionally developed set of rationalizations that responds defensively to contrary evidence, actively discrediting such evidence or its source without logical justification.
Some would think those who are highly educated are immune to confirmation bias and they could set us down the right path. Interestingly, those with more education are more prone to motivated reasoning than those with average educations. It seems the more educated you are the more you think you are right and the more you will cherry pick evidence to support your own views, thus participating in motivated reasoning.
Healthcare is not immune from confirmation bias or motivated reasoning. We are now focusing on evidence-based practice, outcome based interventions and using big data to make decisions. Yet, big data has come under fire as discussed in The Economist post The backlash against big data. Any clinician can tell you about conversations they’ve had with patients and family members who discount studies or evidence they are being presented with.
I’ve heard smokers say they won’t quit smoking because their grandfather lived to be 95 and he smoked a pack of cigarettes a day. What’s a little data to show that’s not the usual outcome? To them, it doesn’t make a difference. They know what they saw and what they experienced with their grandfather. People often value personal experience over numbers and studies. It can be frustrating, but at some level I can identify with them.
When I was pregnant with my daughter, I had pregnancy induced hypertension so I decided to see an acupuncturist. People swore it would work. I figured it wouldn’t hurt so I might as well try it. It did nothing for me. Then when I found out my daughter was breech I was told that moxibustion (the act of holding the smoldering herb Moxa over your toe) would work. I was reassured there was good evidence to prove it was effective. Again, it did nothing for me.
Does that mean these interventions don’t work? Not necessarily. They didn’t work for me but that doesn’t mean they wouldn’t work for someone else.
Acknowledging variations in data is part of overcoming confirmation bias, says Mark Graban in his post Understanding Variation: How I Learned to Ignore the Noise in Data and Focus on Fixes. He also suggests putting data in context, using more than two data points for comparison and not getting sucked into charts and tables of numbers.
In How to ignore the yes man in your head, Jason Zweig suggests jotting down a statement about what would get you to change your view. In this case it was related to an investment portfolio, but it is a great suggestion for anyone trying to implement major change in healthcare.
What if those opposed to EHR use kept a log of what they expected to happen (e.g., less time with patients, increased work load) and compared it to a log of what was actually happening? They might have a different perspective and see they aren’t working longer hours.
The same advice goes for those pushing for the implementation of new technology. You have to acknowledge what is actually happening – nurses working longer shifts – and compare it to what you hoped would happen. We have to be willing to change our views when faced with real-world experiences.
Chris Lee makes a great point in his piece Avoiding confirmation bias about taking feedback and using it to your advantage. He outlines how he tried to poke holes into his own experiment and thought he did a pretty successful job until he presented his idea at a scientific conference. There, another scientist approached him after the presentation and informed him that there was an important hole he overlooked. Yes, it was disappointing, but to his credit he did not take it as a personal attack. Instead, he enlisted the gentleman to help him and his research team find ways around the flaw. Taking this man’s advice led him to design a more solid project.
Have you ever encountered confirmation bias in your work? Tell us what happened and how (or if) you were able to overcome it.
Jennifer Thew, RN, MSJ
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